Senior Appeals Specialist
Open To Work
GYNERA BARRY
Independence Blue Cross
Newark,DE
Work Preference
Job Search Status:
Open to work
Desired start date:
Immediately
Desired Job Title
Senior Appeals SpecialistSenior Client Setup AnalystExecutive Inquiries SpecialistAppeals SpecialistAppeals Coordinator
Work Type
Full Time
Location Preference
RemoteHybrid
Location:
Newark, DE
Open to relocation:
No
9
years of professional experience
Results-driven healthcare insurance operations professional with expertise in member advocacy, benefit configuration, and issue resolution. Researches complex issues, identifies root causes, and collaborates with internal partners to ensure compliance with regulatory standards. Delivers accurate responses and effectively manages high-volume workloads while maintaining service-level commitments.
Work History
Senior Appeals Specialist
2 Years 2 Months- Performed in-depth examination of benefit language claims and associated documentation to enhance appeal resolution processes for members and providers.
- Coordinated with internal teams to gather case information, validate appeal determinations, and ensure compliant, timely appeal processing.
- Maintained accurate case notes and documentation to enhance audit readiness and facilitate clear decision-making.
- Managed multiple appeal cases in a deadline-driven environment while upholding quality, confidentiality, and service expectations.
Senior Client Setup Analyst
1 Year- Assessed client setup requests for accuracy and completeness, collaborating with internal teams to address discrepancies and confirm requirements for timely client onboarding.
- Executed configuration of new client benefits and coordinated renewal activities, guaranteeing correctness in plan specifications and benefit administration.
- Executed modifications to client benefit setups, addressing updates, corrections, and renewal-related changes to maintain compliance.
Executive Inquiries Specialist
6 Years 1 Month- Resolved escalated inquiries and complaints through in-depth research of complex customer concerns across multiple lines of business, ensuring accurate issue resolution and effective member communication by analyzing relevant policies, procedures, contracts, and account details.
- Led cross-functional teams to implement strategic initiatives enhancing operational efficiency.
- Developed and executed comprehensive training programs for new employees, fostering a culture of continuous improvement.
- Analyzed performance metrics to identify trends, driving data-informed decision-making across departments.
Education
Bachelor Degree - Healthcare Administration
Skills
Appeals resolution
Insurance operations
Benefits management
Investigation management
Root cause analysis
Implementation support
Inquiry management
SLA management
Process optimization
HIPAA Awareness
Microsoft Excel
Customer Advocacy
Written communication
Collaborative teamwork
Inventory management
Timeline
Senior Appeals Specialist
Independence Blue Cross
10.2023 - 12.2025Read More
Senior Client Setup Analyst
Independence Blue Cross
10.2022 - 10.2023Read More
Executive Inquiries Specialist
Independence Blue Cross
09.2016 - 10.2022Read More
Herzing University
Bachelor Degree from Healthcare Administration
Read More