ELEANOR (ELLY) DOBSON
Summary
Senior Medical Insurance Business Analyst with 30+ years of comprehensive experienceacross medical claims billing/coding, claims adjudication, appeals reconciliation, business acceptance application testing, clinical code editing and Workers’ Compensation claim reviews. Recognized for delivering accurate analysis, driving process improvements, and supporting business objectives through strong collaboration and independent problem‑solving. Brings exceptional analytical, communication, and organizational capabilities, along with adaptability and disciplined time management. A results‑oriented professional committed to operational efficiency, continuous improvement, and adding measurable value to the organization.
Overview
31
31
years of professional experience
Work History
Group Medical Customer Service Representative, Facets Claims Analyst, Appeals Specialist, Payor Solutions Senior Pricing Analyst, Business Project Senior Analyst
Great West Healthcare/ Cigna Healthcare
St. Louis, MO
01.2001 - 11.2023
- Detailed records documenting procedures, methodologies, and sources of information employed while performing analytical tasks.
- Analyze operational data to identify areas for improvement in efficiency and cost savings.
- Monitor individual/team progress against goals and objectives; provided timely updates to stakeholders.
- Collaborate with cross-functional teams to develop business strategies that drive growth initiatives.
- Provided training and support to team members on data analysis tools and processes.
- Creation and execution of test plans and test cases
- Identified and resolved data discrepancies to ensure accuracy.
- Provided analytical support for strategic initiatives and projects.
- Built relationships with internal stakeholders to understand needs better.
- Analyze complex information, identify discrepancies, and make informed decisions about claim validity
- Utilize Excel, ALM, Jira, Tableau
- Designed processes to verify compliance with corporate policies and government regulations regarding pricing structure and discounting practices.
- Provided guidance and support on various topics such as health plan options and benefits eligibility criteria.
- Researched complex cases involving billing discrepancies or insurance coverage issues.
- Utilized effective communication techniques to resolve patient inquiries and complaints promptly and professionally.
- Ensure compliance with HIPAA regulations with internal and external customers.
Part time International Package Processor
United Parcel Service
Rockford, IL
09.2000 - 03.2001
File Clerk, Workers Compensation Medical Bill Payment Specialist, Assistant Claims Supervisor
Liberty Mutual Insurance Co.
Rockford, IL
03.1993 - 04.2000
Education
Business Administration
Rock Valley College
Rockford, IL01.1990
High School - undefined
Harlem High School
Machesney Park, IL06.1988
Skills
- Proficient in Excel, Word, Outlook, PowerPoint, ALM, Jira, Zephyr, Confluence, Tableau, EncoderPro, Trucare
- Strong understanding of medical terminology and coding including CPT, HCPCS, ICD10, DRG, Optum, contract pricing, secondary savings, clinical code editing, claims adjudicating and prior authorizations
- Familiar with Agile Methodologies
- Outstanding analytical, communication, problem-solving, organizational, adaptability and time management skills
- Completion of self-study courses for Agile, Excel & improving work ethics
- Manage time effectively and prioritize tasks to meet deadlines
- Adapt to changes in regulations, policies, and technology
- Identify and resolve issues related to claim processing, billing, and other related matters
- Analyze complex information, identify discrepancies, and make informed decisions about claim validity
- Excellent written and verbal communication skills to interact with healthcare providers, patients, and other stakeholders
- Ensures high level of accuracy and attention to detail for reviewing claims and ensuring proper documentation
- Proficient in EDI applications, creation and execution of Test Plans and Test Cases
Timeline
Group Medical Customer Service Representative, Facets Claims Analyst, Appeals Specialist, Payor Solutions Senior Pricing Analyst, Business Project Senior Analyst
Great West Healthcare/ Cigna Healthcare
01.2001 - 11.2023
Part time International Package Processor
United Parcel Service
09.2000 - 03.2001
File Clerk, Workers Compensation Medical Bill Payment Specialist, Assistant Claims Supervisor
Liberty Mutual Insurance Co.
03.1993 - 04.2000
High School - undefined
Harlem High School
Business Administration
Rock Valley College