Summary
Overview
Work History
Education
Skills
Affiliations
Accomplishments
U.S Army Veteran
Timeline
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ERIC THOMPSON

Seffner,FL

Summary

Motivated professional with a strong work ethic and adaptability. Proven ability to excel in unsupervised environments while mastering new skills rapidly. Expertise in customer service, multitasking, and time management, ensuring positive experiences for customers and team members. Strong analytical and communication skills drive optimal results in all tasks.

Overview

13
13
years of professional experience

Work History

Clinical Provider Auditor

Elevance
Tampa, Florida
08.2012 - Current
  • Identified potential fraud and abuse risks through a detailed examination of claims.
  • Analyzed claims and medical records for compliance with billing guidelines prior to payment.
  • Documented determinations accurately using required systems, advancing claims in their lifecycle.
  • Maintained open communication with external auditors regarding coordination of audits.
  • Ensured timely completion of all assigned tasks within set deadlines.
  • Worked closely with management to discuss external audit results and action plans.

Investigator Assistant

Elevance
Tampa, Florida
08.2020 - 03.2024
  • Validated claims data against guidelines to ensure compliance and accuracy.
  • Conducted comprehensive statistical and financial analyses for reporting purposes.
  • Managed initial file setups while tracking cases through inquiries.
  • Investigated assigned cases by analyzing claim data to identify fraudulent activities.
  • Collaborated with training department to maintain accurate policies and procedures.
  • Requested necessary medical records and documentation for thorough investigations.
  • Handled confidential information with utmost integrity and discretion.
  • Assisted in developing innovative policies to enhance operational efficiency.
  • Trained investigators and worked with team lead to identify, problem areas, and opportunities for staff development and improvement.

Operations Expert

Anthem
Tampa, Florida
07.2013 - 08.2020
  • Identified issues, analyzed coverage, and recommended payment or denial decisions.
  • Ensured compliance with state and federal regulations and Anthem guidelines.
  • Monitored claims inventory to achieve 15-day turnaround time using Report Manager software.
  • Assigned urgent claims to analysts based on proficiency levels for efficient processing.
  • Reviewed claims returned by Quality Team or health plan, assisting analysts in reprocessing.
  • Analyzed documentation to verify issues and conducted research to identify errors.
  • Utilized training opportunities to enhance quality of analysts' work products.
  • Delivered remote and on-site training for telecommuting and in-house analysts to boost accuracy.
  • Created process documentation and trained staff on new systems.

Customer Service Representative

Amerigroup
Tampa, Florida
08.2012 - 07.2013
  • Answered inbound calls, providing accurate coverage and copayment information to customers.
  • Assisted coaches and team leads by offering additional support on the call center floor.
  • Handled escalated customer calls and guided representatives through queries and concerns.
  • Praised individuals or teams for daily K.P.I. excellence.
  • Fostered strong customer relationships through personalized assistance and support.
  • Resolved complex issues by collaborating with departments to meet customer needs.
  • Addressed customer inquiries with precise product and service information.

Education

Associate of Arts - Physical Education

Southern Illinois University, Carbondale
Carbondale, IL
05-1996

Skills

  • Claims analysis
  • Document management
  • Problem solving
  • Time management
  • Decision making
  • Multitasking and organization
  • Clear communication
  • Attention to detail
  • Employee motivation
  • Compliance auditing
  • Process improvement

Affiliations

Referee FL state Highschool Football and basketball and Girls Flag 15 years. Been chosen to Officiate State Championship games in 2020 and 2023

Accomplishments

5 time Impact award

U.S Army Veteran

Served United States Armed Forces 1988 to 1992 Operation Desert  Storm. Honorable discharge  

Timeline

Investigator Assistant

Elevance
08.2020 - 03.2024

Operations Expert

Anthem
07.2013 - 08.2020

Clinical Provider Auditor

Elevance
08.2012 - Current

Customer Service Representative

Amerigroup
08.2012 - 07.2013

Associate of Arts - Physical Education

Southern Illinois University, Carbondale

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