Erin Edington
Brazil,IN
Summary
Motivated Claims Manager with extensive experience at Indiana Laborers Welfare Fund, excelling in ERISA compliance and health plan oversight. Proven track record in enhancing claims operations and fostering vendor relationships, resulting in improved service delivery. Adept at data analysis and team leadership, driving efficiency and compliance in complex claims environments.
Overview
8
8
years of professional experience
Work History
Claims Manager
Indiana Laborers Welfare Fund
Terre Haute, IN
02.2021 - Current
- Managed claims processing for health benefits under Indiana Laborers Welfare Fund guidelines.
- Developed and implemented workflow enhancements to streamline claims operations.
- Prepared detailed reports on claim status and activities for management review.
- Negotiated contracts relating to third-party providers used by the organization in support of its claim's operations activities.
- Coordinated with internal departments such as IT, Human Resources, Accounting, Legal Services. to ensure that all relevant information was available for decision making purposes.
- Established strong relationships with external vendors providing services related to claims operations in order to ensure optimal service delivery at competitive rates.
- Analyzed financial documents such as budgets, forecasts, invoices. related to claims operations activities in order to ensure accurate reporting of expenses and costs associated with these functions.
- Checked vendor payments and other accounting disbursements for accuracy and compliance.
Administrative Assistant to the Claims Manager
Indiana Laborers Welfare Fund
Terre Haute, IN
11.2020 - 02.2021
- Reviewed and adjudicated complex claims ensuring compliance with regulations.
- Supervised a team of claims analysts, providing guidance and support daily.
- Resolved escalated customer issues by providing effective solutions in a timely manner.
- Prepared detailed reports on claim status and activities for management review.
- Created processes for tracking open cases, monitoring progress towards resolution goals.
Claims Examiner
Indiana Laborers Welfare Fund
Terre Haute, Indiana
07.2017 - 10.2020
- Reviewed and processed claims for eligibility and compliance.
- Communicated with members to clarify claim details and requirements.
- Collaborated with healthcare providers to verify medical documentation.
- Assisted in training new staff on claims processing procedures.
- Paid and processed claims within designated authority level.
- Communicated with personnel and legal counsel on claims involving litigation.
Education
Some College (No Degree) - Business Administration
Indiana State University (Some College-No Degree)
Terre Haute, INSkills
- ERISA Compliance
- Self-Funded Health Plan Administration
- HIPAA Compliance
- Appeals & Grievance Handling
- Coordination of Benefits
- Stop-Loss Insurance Administration
- Health Plan Contract Negotiation
- Vendor Managements (PBMs, TPAs, networks)
- Policy and Procedure Development
- Health Plan Reporting & Data Analysis
- Medicare Coordination
References
References available upon request.
Timeline
Claims Manager
Indiana Laborers Welfare Fund
02.2021 - Current
Administrative Assistant to the Claims Manager
Indiana Laborers Welfare Fund
11.2020 - 02.2021
Claims Examiner
Indiana Laborers Welfare Fund
07.2017 - 10.2020
Some College (No Degree) - Business Administration
Indiana State University (Some College-No Degree)
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