GLORIA ROGERS
University Park,IL
Summary
Analytical Claims Adjudicator with 15 years of positive experience. Adept at performing data acquisition and analysis to validate insurance claims. Bringing in-depth knowledge of claims negotiation and document processing to contribute positively to a companies growth and development. Methodical Claims Adjudicator offering 15 years of insurance industry expertise, including advanced knowledge of claims and policy regulations. Eager to secure a Claims Adjudicator role to contribute immediate value to team.
Overview
11
11
years of professional experience
Work History
Health Insurance Claims Adjudicator
Evolent Health
2017.11 - 2024.05
- Knowledge in processing Medical Claims, Dental Claims , Vision Claims, Medicare, and Medicaid Claims
- Analyze medical records, billing codes, and supporting documentation to determine coverage and eligibility.
- Collaborate with healthcare providers, policyholders, and medical billing specialists to resolve claim-related issues.
- Ensure timely and accurate adjudication of claims within established guidelines and service level agreements.
- Uphold confidentiality and adhere to privacy regulations in handling sensitive patient information.
- Maintain accurate records of claims, correspondence, and other relevant documentation.
- Provide exceptional customer service by addressing inquiries and concerns related to claims processing.
- Worked Subrogation claim
- Knowledge in processing Medical Claims, Dental Claims, Vision Claims, Medicare, and Medicaid Claims
- Collaborated with healthcare providers and policyholders to resolve claim discrepancies and ensure accuracy.
- Maintained a high level of productivity and met or exceeded performance targets for claims processing.
- Assisted in training new employees on claims processing procedures and company policies.
Claims Adjudicator II
Valence Health
2015.09 - 2017.11
- Medical, Dental Investigated and processed Medical, Dental, Vision insurance claims for policyholders.
- Collaborated with team members and management to meet goals.
- Determined claim status and negotiated to reach reasonable settlements or denials.
- Worked numerous clients
- Verified insurance claims and determined fair amount for settlement.
- Investigated and processed Medical, Dental , Vision insurance claims for policyholders.
- Worked Post Team Duties
Claims Auditor
Accent Recovery
2013.02 - 2015.09
- Prioritized daily tasks to satisfy workload demands and department's turnaround goals. Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues.
- Audited Provider claims for overpayments
- Met Goals for overpayments
Education
Business Administration
Olive Harvey College
Chicago, ILSkills
- Claims Processing
- Policy Interpretation
- Medical Coding
- Customer Service
- Medical record review
- Insurance claims processing
- Quality assurance checks
- Thorough claims reviews
- Organizational abilities
- Insurance Verification
- HIPAA
- Medical Terminology
- Critical Decision-Making
- Knowledgeable in Insurance Software
- Insurance Claims
- Teamwork and Collaboration
- Problem-Solving
- Time Management
- Attention to Detail
- Problem-solving abilities
- Multitasking
- Claims Investigation
- Multitasking Abilities
- Excellent Communication
- Critical Thinking
- Computer Skills
- Effective Communication
Additional Information
Also worked for Cigna Healthcare ,United Healthcare , Unicare Healthcare in various roles
Timeline
Health Insurance Claims Adjudicator
Evolent Health
2017.11 - 2024.05
Claims Adjudicator II
Valence Health
2015.09 - 2017.11
Claims Auditor
Accent Recovery
2013.02 - 2015.09
Business Administration
Olive Harvey College
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