Eileen Spiak
Toms River,NJ
Summary
Quick Learner and motivated
Likes dealing with the senior population.
History of explaining comprehensive medical plan and how to best file claims, and coverage and potential reimbursement.
Participated in testing new updates to processing system.
Dealt with customer complaint escalated calls
Overview
28
28
years of professional experience
Work History
Corebridge Financial
AIG American General
11.2000 - 08.2023
- Processed Catastrophic Medical Claims
- Handled over 30 in coming customer calls per day
- Assisted with escalated calls
- Tested enhancements to processing application.
- Processed 20 different policies according to policy provisions
- Identified opportunities to improve business process flows and productivity
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements
- Followed up with customers on unresolved issues
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources
- Provided advice to customers regarding claims, rights and insurance processes to prevent disputes
- Escalated files with significant indemnity exposure to supervisor for further investigation
- Utilized appropriate cost containment techniques to reduce overall claim costs
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues
- Examined claims forms and other records to determine insurance coverage
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims
LPN Charge Nurse
Genesis Rehab
01.1996 - 09.2000
- Delivered direct quality care to patients by evaluating medical conditions and managing and assessing treatments.
- Assessed patients' temperature, pulse, and blood pressure and recorded in electronic medical records.
- Assembled and used equipment such as catheters, tracheotomy tubes, or oxygen suppliers to effectively manage patient care.
- Analyzed patient assessments and laboratory data to bring any issues to attention of physicians.
- Served as charge nurse, caring for patients with serious illnesses.
- Documented vitals and medical histories in patient charts when assessing patients and communicated patient information to physicians and other nurses for care continuity.
- Established cordial relationships with medical personnel and staff to promote teamwork and maintain positive attitude.
- Assisted in coordinating transfers, discharges and admissions to establish smooth transition of patients.
- Collaborated with interdisciplinary teams to establish proper patient care and provide education to patients and family members.
- Led and mentored newly licensed nurses and nursing students to develop professional expertise.
- Administered medications and injections to patients.
- Monitored patient health conditions to report changes to assigned physician.
- Delivered emotional support to patients and families during challenging times.
Education
No Degree - Licensed Practical Nursing
Perth Amboy Adult School Practical Nursing
Perth Amboy, NJ01.1986
High School Diploma -
Matawan Regional High School
Matawan, NJ06.1982
Skills
- Microsoft Office Suite
- Policy investigations
- Healthcare Common Procedures Coding System (HCPCS)
- Familiar with fraud statutes
- Insurance policy coverage knowledge
- Claims
- Microsoft Word
- Benefits review
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Price is what you pay. Value is what you get.
Warren Buffett
Timeline
Corebridge Financial
AIG American General
11.2000 - 08.2023
LPN Charge Nurse
Genesis Rehab
01.1996 - 09.2000
No Degree - Licensed Practical Nursing
Perth Amboy Adult School Practical Nursing
High School Diploma -
Matawan Regional High School
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