Diana Crout
Rockford,IL
Summary
Dynamic Provider Advocate Specialist with extensive experience at Blue Cross Blue Shield of Illinois, excelling in analytical reasoning and problem-solving. Proven track record of enhancing customer satisfaction through efficient claim resolution and fostering collaborative relationships. Skilled in case preparation and document management, consistently achieving high-quality outcomes in complex medical claims.
Overview
6
6
years of professional experience
Work History
Provider Advocate Specialist
Blue Cross Blue Shield of Illinois
04.2023 - 03.2025
- Managed complex caseloads with diligence, prioritizing tasks to ensure timely resolution of cases.
- Conducted comprehensive legal research to support case strategy and contributed to significant legal victories.
- Managed sensitive cases with discretion, protecting client confidentiality and trust.
- Kept up-to-date on case progress by frequently reviewing records and reporting findings to clients.
- Provided administrative support and research for civil litigation and civil proceedings.
- Collected and prepared pre-trial discoveries, records and evidence displays.
- Followed all company policies and procedures to deliver quality work.
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
- Collaborated with cross-functional teams to achieve project goals on time and within budget.
- Enhanced customer satisfaction with timely and accurate issue resolution.
- Gathered, organized and input information into digital database.
- Created and managed project plans, timelines and budgets.
Senior Claims Examiner
Blue Cross Blue Shield of Illinois
03.2021 - 03.2023
- Reduced claim resolution time by conducting thorough investigations and timely decisionmaking.
- Developed and maintained relationships with key stakeholders, fostering a cooperative working environment.
- Enhanced customer satisfaction through prompt communication and comprehensive claim explanations.
- Contributed to company growth by consistently meeting or exceeding productivity targets without sacrificing quality standards.
- Maintained up-to-date knowledge of industry trends and legislative changes, ensuring accurate claim evaluations.
- Maintained compliance with industry regulations and company policies while evaluating medical claims for accuracy and legitimacy.
- . Achieved excellent outcomes for both patients and healthcare providers by applying sound judgment in adjudicating complex medical claims.
- Reduced errors in claim submissions by meticulously reviewing patient information and verifying insurance eligibility.
- Managed large volume of medical claims on daily basis.
- Researched and resolved complex medical claims issues to support timely processing.
Claims Examiner
Blue Cross Blue Shield of Illinois
05.2019 - 03.2021
- Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
- Continuously sought opportunities for process improvement, contributing innovative ideas to enhance overall departmental efficiency and effectiveness.
- Maintained compliance with industry regulations and company policies while evaluating medical claims for accuracy and legitimacy.
- . Achieved excellent outcomes for both patients and healthcare providers by applying sound judgment in adjudicating complex medical claims.
- Reduced errors in claim submissions by meticulously reviewing patient information and verifying insurance eligibility.
- Managed large volume of medical claims on daily basis.
Education
Bachelor of Science - Business Administration
DeVry Education Group
Chicago, ILSkills
- Analytical reasoning
- Benefits administration
- Case preparation
- Active listening
- Collaboration and teamwork
- Creative and critical thinking
- Written communication
- Document management
- Judgement and decision making
- Attention to detail
- Effective multitasking
- Building trust and relationships
- Time management
- Administrative support
- Support services
- Document preparation
- Organization and administration
- Deadline adherence
- Database management
- Discovery and document review
- Analytical thinking
- Task prioritization
- Excellent communication
- Teamwork and collaboration
- Problem-solving abilities
- Effective communication
Accomplishments
- Used Microsoft Excel to develop claims analysis spreadsheets.
Languages
English
Native or Bilingual
Software
AS400
Microsoft Excel
Salesforce
CMS
Timeline
Provider Advocate Specialist
Blue Cross Blue Shield of Illinois
04.2023 - 03.2025
Senior Claims Examiner
Blue Cross Blue Shield of Illinois
03.2021 - 03.2023
Claims Examiner
Blue Cross Blue Shield of Illinois
05.2019 - 03.2021
Bachelor of Science - Business Administration
DeVry Education Group
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