Dianna Sida
Sacramento,CA
Summary
Seasoned Senior Claims Examiner known for high productivity and efficient task completion. Experienced and detail-oriented Medical Billing and Call Center Specialist with over 10 years of experience in claims processing, customer support, and team leadership. Proficient at navigating complex healthcare systems, managing high-volume workflows, and providing exceptional service to members and providers. Skilled in facilitating effective communication, managing grievances, and ensuring compliance with health plan policies and procedures.
Overview
18
18
years of professional experience
Work History
Claims Examiner II
Elevance Health (Anthem)
Rancho Cordova, CA
06.2012 - 07.2024
- Interpreted and communicated complex health plan policies, procedures, and functions to beneficiaries, ensuring clarity and understanding
- Processed medical, Medicare, and commercial claims, consistently achieving high accuracy and timely resolution
- Managed ongoing grievance tracking and reporting for assigned members and providers, ensuring compliance with organizational standards
- Executed prior authorization requests, utilizing system applications and medical documentation to ensure compliance and efficiency
- Navigated multiple internal platforms to resolve claims issues and facilitate issue escalation, improving operational efficiency
Subject Matter Expert (SME)
EDS, HP Company
Rancho Cordova, CA
03.2006 - 07.2011
- Provided expert support in handling high-volume Medicaid escalated calls, resolving complex issues and ensuring customer satisfaction
- Collaborated with members and providers to resolve claims issues, providing detailed explanations and facilitating claim adjustments as needed
- Maintained performance metrics, ensuring compliance with service level agreements and operational goals
- Conducted in-depth research and processed Claims Detail Reports, ensuring accuracy and timely resolution of member inquiries
- Assisted the management team by offering leadership support and contributing to training and development initiatives
Education
Dental assisting License -
Western Career College
01.2005
High School Diploma -
Luther Burbank High School
01.2003
Skills
- Medical Billing & Claims Processing
- Call Center Operations & Leadership
- Prior Authorization & Grievance Management
- Cross-Functional Collaboration
- Verbal & Written Communication
- Technical Proficiency
- Policy interpretation
- Microsoft Office Suite
- Claims processing
- Medicaid
- Managed care
- Claim appeals handling
- EOB analysis
- Medicare expertise
- ICD-10 proficiency
- HIPAA
- Payment posting
- Claim denials management
- Critical Decision-making
- Medical terminology
- Healthcare subject matter expert
- CPT code mastery
- Telephone etiquette
- Customer service
Timeline
Claims Examiner II
Elevance Health (Anthem)
06.2012 - 07.2024
Subject Matter Expert (SME)
EDS, HP Company
03.2006 - 07.2011
Dental assisting License -
Western Career College
High School Diploma -
Luther Burbank High School