Summary
Overview
Work History
Education
Skills
Timeline
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Elisabeth Hoerger

Indianapolis,IN

Summary

Organized and seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills. Willingness to take on added responsibilities to meet team goals.

Overview

20
20
years of professional experience

Work History

Javelina Business Analyst

WorldTrips
09.2023 - Current
  • Audited 200 Plan Builds
  • Built 25 Plans
  • Performed weekly data integrity checks between internal (Javelina) and external (United Health Care Global) financial systems
  • Liaison with Claims troubleshooting plan builds.

CLAIM SUPERVISOR

WorldTrips
06.2022 - Current
  • Assists Manager in evaluating department procedures and workflow regularly to identify opportunities for improvement
  • Provide guidance to & manage multiple stakeholders in the management of complex claims
  • Identify trends and partner with Support team and Management to make recommendation and improve operational performance
  • Reviews job performance, and provides direct feedback related to performance and success for each direct report
  • Evaluates overall performance of team as well as individuals
  • Coaches and counsels team members both individually and together toward improved performance
  • Develop good working relationships and workflows with other operational departments that impact claims processing
  • Manage the ongoing personal development, competency and performance of all direct reports.

CLAIM EXAMINER

WorldTrips
08.2014 - 06.2022
  • Established proof of loss by requesting required information from variety of sources including claimants, physicians and hospitals
  • Determined eligibility and benefits for medical insurance losses by reviewing conditions of policy or certificate
  • Investigated questionable claims and supporting documentation to identify fraud
  • Documented medical claims actions by providing detailed notes on each claim and incident of care
  • Resolved medicals claims by calculating benefits due and initiating payment, or denying based on policy
  • Maintained quality customer service by ensuring timely and fair processing of claims
  • Responded to customer service inquiries regarding claim and document submission and determination of claims eligibility.

ASSOCIATE UNDERWRITER

United Healthcare
03.2004 - 04.2014
  • Analyzing applicant's medical background, including factors such as age, personal health history and family health history
  • Requesting medical records to verify information given on application
  • Preparing questions to be asked by customer service to further verify information received in records
  • Coordinating with other experts for nuanced opinions
  • Retrieving additional external data to aid in decision-making, i.e
  • Medical Information Bureau
  • Determine appropriate action to be taken once all information has been received/analyzed-offer coverage with/without riders or decline.

Education

Associate of Science - Nursing

Ivy Tech Community College of Indiana
Indianapolis, IN

Skills

  • Service Now
  • Microsoft Office
  • Multitasking Communication
  • Troubleshooting
  • Time management
  • Data Analysis
  • Customer Support
  • Collaboration
  • Data analysis
  • Process Improvements
  • Strategic Planning
  • Requirements Gathering
  • Product Knowledge

Timeline

Javelina Business Analyst

WorldTrips
09.2023 - Current

CLAIM SUPERVISOR

WorldTrips
06.2022 - Current

CLAIM EXAMINER

WorldTrips
08.2014 - 06.2022

ASSOCIATE UNDERWRITER

United Healthcare
03.2004 - 04.2014

Associate of Science - Nursing

Ivy Tech Community College of Indiana

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Elisabeth Hoerger