Gena Forshee
Beaver Dam,WI
Summary
Detail-oriented LPN and Claims Examiner III with 13 years of experience at Wisconsin Physicians Service Insurance (within the TRICARE for Life contract). Professional with comprehensive experience in claims processing and evaluation. Demonstrates strong analytical skills, thorough knowledge of insurance policies, and consistent track record of identifying and resolving complex claims. Valued team player with strong focus on collaboration and results, adaptable to evolving work environments. Known for reliability, problem-solving abilities, and effective communication.
Overview
17
17
years of professional experience
Work History
Claims Examiner III - LPN
Wisconsin Physicians Service Insurance
05.2011 - Current
- Handle complaints and grievances using negotiating and problem-solving skills.
- Communicate with beneficiaries and providers by telephone, emails, and letters.
- Researched complaints to deliver solutions and resolve problems.
- Identified health insurance payment guidelines with thorough examinations of claims documentation and related records.
- Request and review medical records for pre/post payment audits.
- Data mining for possible fraudulent providers. Then research and build cases for government review.
- Process prepayment claims.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
Licensed Practical Nurse
THI of WI Hartford, LLC - The Highland
11.2007 - 03.2010
- Improved patient outcomes by administering medications, monitoring vital signs, and documenting relevant information.
- Cared for wounds, provided treatments, and assisted with procedures.
- Assisted with admissions, appointments, transfers, and discharges.
- Collaborated with interdisciplinary healthcare teams to ensure continuous quality improvement in patient care delivery.
- Facilitated efficient communication between patients, families, and healthcare providers to promote continuity of care across settings.
- Managed time-sensitive tasks effectively under pressure while maintaining composure during critical situations or emergencies.
- Administered medications and injections to patients.
Education
Certified Coding Specialist - Health Information Technology
Moraine Park Technical College, Beaver Dam, WI
Beaver Dam, WI05.2022
Licensed Practical Nurse - Nursing
Moraine Park Technical College, Beaver Dam, WI
Beaver Dam, WI02.2005
Skills
- Microsoft Office Suite
- Verbal Communication
- Claims Processing
- Critical Thinking
- Claims Evaluation
- Active Listening
- Policy investigations
- Decision-Making
- Team Collaboration
- Claims Investigation
- Organizational Skills
- Analytical Skills
- Time Management
- Multitasking
- Attention to Detail
Timeline
Claims Examiner III - LPN
Wisconsin Physicians Service Insurance
05.2011 - Current
Licensed Practical Nurse
THI of WI Hartford, LLC - The Highland
11.2007 - 03.2010
Certified Coding Specialist - Health Information Technology
Moraine Park Technical College, Beaver Dam, WI
Licensed Practical Nurse - Nursing
Moraine Park Technical College, Beaver Dam, WI
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