ERNEST GRIPPER
Hampton,VA
Summary
Seasoned Claims Specialist with a comprehensive background in insurance claim processing, policy interpretation, and dispute resolution. Have successfully managed high-volume claims environments, demonstrating keen ability to stay organized under pressure. Known for strong analytical skills, adept at reviewing documentation and validating coverage decisions. Consistently ensure prompt, fair settlements while maintaining compliance with industry regulations.
Overview
13
13
years of professional experience
Work History
Claims Specialist/Audit Senior
Allianz Global Corporate & Specialty
Richmond, VA
09.2021 - 11.2024
- I reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Handled a high volume of claims diligently.
- Resolved claims by approving or denying documentation, calculating benefits due, and determining compensation settlements.
- Reviewed police reports, medical treatment records, medical bills, and physical property damage to determine the extent of liability.
- Maintained up-to-date knowledge of regulatory changes affecting claims processing.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Remained professional at all times, especially when speaking to customers, or responding to messages, to represent the company's high level of service.
Claims Analyst
Anthem
Virginia Beach, VA
01.2020 - 04.2020
- Provide claims support reviewing, researching, investigating, auditing claims
- Analyze and identify trends and provide feedback and reports
- Analyze information and utilize results to build recommendations to reduce errors and improve process performance
- Perform post production support by performing knowledge transfer to Support team to ensure they are able to investigate and resolve issues; provide guidance and/or help in investigating and resolving issues
- Served as subject matter resource to team members, supervisors and management staff
Claims Processor
WPS Health Solutions
Hampton, VA
06.2018 - 01.2020
- Research and Analyze claims issues to determine if eligibility requirements and filing requirements were met
- Calculate with other health insurance amounts using data from the claims, such as EOB or prior payment information given
- Settle specialty claims including, pharmacy, ambulatory and surgery claims
- Reprocessed necessary claims based on changes such as Ambulatory, Durable Medical Equipment (DME) or Institutional based charges
- Provided letters to providers and beneficiaries for missing claim information to process claim accurately
- Tactfully dealt with a wide variety of people in different situations to convey a favorable corporate image
Senior Risk Associate/Team Lead
Capital One
Chesapeake, VA
01.2012 - 06.2018
- Reviewed customer account to analyze and resolve the root causes of the customer's account issues
- Provided timely responses to all calls and email inquiries while staying current on all company ever changing procedures
- Advised and coached a team of 13 employees with daily business standings and updates from my daily meeting with the leadership team, while maintaining my production staying within the top 10% of the department
- Managed customer calls effectively and efficiently in a fast paced and challenging call center environment
Education
Some College (No Degree) - BUSINESS MANAGEMENT
MORGAN STATE UNIVERSITY
Baltimore, MDSkills
- Complex claims consulting
- Strong verbal communication
- Claims investigation
- Microsoft Office
- Compliance management
- Settlement management
- Claims processing
Occupational licenses certificates training
U.S. Army Reserve, Honorably Discharged in May 1995
Timeline
Claims Specialist/Audit Senior
Allianz Global Corporate & Specialty
09.2021 - 11.2024
Claims Analyst
Anthem
01.2020 - 04.2020
Claims Processor
WPS Health Solutions
06.2018 - 01.2020
Senior Risk Associate/Team Lead
Capital One
01.2012 - 06.2018
Some College (No Degree) - BUSINESS MANAGEMENT
MORGAN STATE UNIVERSITY
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