Dyshona Cooper
Florham Park,NJ
Summary
Dynamic claims processing and billing specialist with a proven track record at CARISK PARTNERS, recognized for enhancing claims resolution efficiency. Expertise in managing complex client interactions leads to improved operational performance and client satisfaction. Exceptional organizational skills contribute to streamlined processes and successful outcomes. Seeking to leverage these strengths in a challenging role that demands both precision and customer engagement.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Worker’s Compensation Claims Payer Biller
CARISK PARTNERS
Florham Park, USA
07.2019 - Current
- Oversaw resolution and management of denied bills under NYS Workers Compensation framework.
- Oversee account handling for radiology facility claim submissions.
- Handled appeal processes with carriers to resolve payment issues.
- Generate Monthly Bill Status Requests for Imaging Facilities.
- Communicated regularly with attorneys about status of Workers Compensation cases.
- Generated and distributed month-end statements for customers and resolved related concerns.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Verified accuracy of claims coding using ICD-10 standards.
- Handled collection and posting of patient account payments.
Consumer Auto Claims Representative
SEDGWICK CLAIMS MANAGEMENT
Whippany, USA
10.2016 - 07.2019
- Established and organized new claims within a fast-paced environment.
- Oversaw claims related to first party property, casualty, and medical reimbursement according to specific client programs.
- Relayed claim decisions effectively to clients and claimants.
- Oversaw proper settlement review in line with specified authority level.
- Created comprehensive summaries highlighting key performance metrics for senior leadership.
Technical Assistant I, Commercial Insurance
LIBERTY MUTUAL INSURANCE
Roseland, USA
11.2015 - 10.2016
- Provided support and coordination to designated technical teams based on department operations knowledge.
- Compiled and analyzed data to verify reliability.
- Served as a technical resource supporting internal and external stakeholders.
- Offered administrative assistance by drafting documents.
- Administered regular compensation payments on a monthly and weekly basis.
Contractor, Liberty Mutual Insurance Company
ICONMA
Troy, USA
08.2015 - 10.2015
- Facilitated timely electronic submission workflows for NYS workers compensation claims.
- Tracked project progress to uphold established timelines.
- Supported contract preparation processes while ensuring compliance with governing laws.
- Informed clients of progress status updates continuously.
Licensed Insurance Producer-Health & Benefits
ADP INSURANCE AGENCY
Florham Park, USA
12.2013 - 03.2015
- Facilitated employee understanding of benefits and plan design details across seventeen states, including NJ.
- Verified accuracy and completeness of all service requests submitted to insurance companies per their specifications.
- Served as employee advocate to address disputes with insurance carriers.
Disability Claims Examiner (Waiver of Premium-Life Product)
PRUDENTIAL FINANCIAL
Roseland, USA
08.2006 - 05.2013
- Handled assignments involving highly complex disability cases.
- Engaged with internal and external stakeholders to support informed decision-making on claims.
- Reviewed and determined outcomes for Disability Income and Waiver of Premium claims in contestable and non-contestable situations.
- Effectively coordinated specialty resources from various sectors to ensure optimal claim management results.
- Collaborated with colleagues in order to ensure accuracy of decisions rendered on claims.
- Participated in training sessions designed to improve knowledge of current policies and procedures.
Senior Data Analyst
CIGNA HEALTHCARE
Jersey City, USA
11.2000 - 07.2005
- Credentialed physicians and hospitals in compliance with Cigna medical guidelines.
- Oversaw fee payment processes efficiently.
- Organized provider modification backlog efficiently through remote management.
- Maintained accuracy of datasets by performing regular quality assurance checks.
Claims Examiner
AETNA/US HEALTHCARE
Cranbury, USA
01.2000 - 09.2000
- Ensured provider and medical group payments through processing of claims, EOBs, and HCFAs.
- Guaranteed adherence to weekly production and quality benchmarks.
- utilized ICD-9 and CPT codes to interpret medical procedures.
- Investigated potentially fraudulent claims with focus on thoroughness, quality, and cost control.
- Reviewed medical records and documents to determine coverage eligibility of claims for insurance benefits.
Research Administrator
UNIVERSITY OF MEDICINE/DENTISTRY OF NJ
New Brunswick, USA
09.1996 - 10.1999
- Oversaw data administration during women's cardiology research.
- Conducted comprehensive training for personnel on women's Cardiology study protocol.
- Designed tracking reports for monitoring member enrollment and study progress.
- Conducted client interviews to assess needs and preferences.
- Provided support for clinical trials, including patient recruitment and scheduling.
- Created and maintained spreadsheets and databases to detail specimen collection and data gathering.
- Monitored compliance with ethical standards throughout the duration of each project.
Education
Diploma - Data Center Support
The Chubb Institute
Jersey City, NJB.S. - Criminal Justice
Rutgers University
New Brunswick, NJSkills
- Experienced in Microsoft Office Applications
- Claims Processing Expertise
- Billing Expertise
- Competent in Coding Languages
- Medical Benefits Oversight
- Research Report Management
- Reception Management
- Managed member/employee benefits
- Oversaw Eligibility Assessments
- Coordinated Lotus Notes Operations
- Coordinated Outlook Functions
- Strong Verbal Communication
- Clear Written Communication
- Strong Attention to Detail
- Strong Organizational Abilities
- Excellent skills in positive interaction with challenging clients
- Excellent skills in effective interaction with challenging customers
- Data entry proficiency
- Patient information management
- File management
- Dispute resolution
- Spreadsheet management
- Invoice review
Certification
Life, Accident, Health or Sickness Producer License, 2013
Timeline
Worker’s Compensation Claims Payer Biller
CARISK PARTNERS
07.2019 - Current
Consumer Auto Claims Representative
SEDGWICK CLAIMS MANAGEMENT
10.2016 - 07.2019
Technical Assistant I, Commercial Insurance
LIBERTY MUTUAL INSURANCE
11.2015 - 10.2016
Contractor, Liberty Mutual Insurance Company
ICONMA
08.2015 - 10.2015
Licensed Insurance Producer-Health & Benefits
ADP INSURANCE AGENCY
12.2013 - 03.2015
Disability Claims Examiner (Waiver of Premium-Life Product)
PRUDENTIAL FINANCIAL
08.2006 - 05.2013
Senior Data Analyst
CIGNA HEALTHCARE
11.2000 - 07.2005
Claims Examiner
AETNA/US HEALTHCARE
01.2000 - 09.2000
Research Administrator
UNIVERSITY OF MEDICINE/DENTISTRY OF NJ
09.1996 - 10.1999
Diploma - Data Center Support
The Chubb Institute
B.S. - Criminal Justice
Rutgers University