ELLA-MAE GALLAGHER
Philadelphia,PA
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
6
6
years of professional experience
Work History
Claims Processor
United Healthcare Group
08.2023 - Current
- Processed claims in diverse queues to maintain timely filing goals
- Verified participant and provider information active status
- Verified ICD-10 codes as complete codes
- Ensured all diagnosis and treatment information aligns with company filing guidelines
- Built OPA's in Incedo to pay out claims
- Verified member insurance coverage and/or service/benefit eligibility
- Maintained 100% quality and efficiency goals
- Remained up-to-date on healthcare, authorization processes, policies and procedures
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
Fraudulent Claims Agent
TD Bank
08.2021 - 08.2022
- Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity
- Analyzed large amounts of data to find patterns of fraud and anomalies
- Contacted customers directly to notify of fraudulent activity and minimize impacts
- Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of fraudulent activity on accounts
- Used coordination and planning skills to achieve results according to schedule
- Worked productively in fast-moving work environment to process large volumes of claims.
- Verified client information by analyzing existing evidence on file.
Records Clerk
Rawle & Henderson LLP
12.2019 - 03.2020
- Prepared files for transfer to other units or for retirement by labeling, listing, boxing and processing files
- Coordinated and collaborated with attorneys to manage files and classified files based on source, type or other details
- Created reports, correspondence and spreadsheets with Microsoft Office programs
- Followed confidentiality regulations to maintain privacy
- Assisted with typing, data entry, and answering incoming calls as required.
Receptionist
Elements Spa
07.2018 - 11.2019
- Confirmed appointments, communicated with clients and updated client records
- Managed multiple tasks and met time-sensitive deadlines
- Resolved customer problems and complaints
- Managed multiple tasks and met time-sensitive deadlines.
Education
High School Diploma -
John W. Hallahan Catholic Girls Highschool
06.2018
Skills
- Detail Oriented
- Time Management
- Quality and efficiency driven
- ICD-10 and CPT code knowledge
- Health Insurance knowledge
- Procedure review
- Authorization review
- Payments posting
- Claims review
- Data entry proficiency
- Claims trend analysis
Timeline
Claims Processor
United Healthcare Group
08.2023 - Current
Fraudulent Claims Agent
TD Bank
08.2021 - 08.2022
Records Clerk
Rawle & Henderson LLP
12.2019 - 03.2020
Receptionist
Elements Spa
07.2018 - 11.2019
High School Diploma -
John W. Hallahan Catholic Girls Highschool
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