Summary
Overview
Work History
Education
Skills
Education and Training
Timeline
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Heather Engle

Provider claims
Zanesville,OH

Summary

Detail-oriented and customer-focused professional with experience in claims processing, data entry, and payment authorization. Adept at evaluating and processing claims with precision, resolving member inquiries, and ensuring compliance with company policies. Strong problem-solving skills with a commitment to accuracy and efficiency. Seeking to grow within the insurance and claims industry by leveraging customer service expertise and analytical abilities.

Overview

27
27
years of professional experience

Work History

Provider Claims Adjudicator

Molina Healthcare
Zanesville, OH
02.2024 - Current
  • Processed and adjudicated medical claims with a 98% accuracy rate, ensuring compliance with Medicaid, Medicare, and private insurance policies.
  • Reviewed, analyzed, and corrected system-generated errors, reducing claim rejections by 20%.
  • Interpreted and processed diverse claims, including CMS 1500 and UB04 forms, while meeting stringent productivity and quality benchmarks.
  • Collaborated with cross-functional teams to investigate claim discrepancies, improving resolution turnaround time.

Healthcare Customer Support Specialist

Molina Healthcare
Zanesville, OH
06.2021 - 02.2024
  • Assisted members with insurance inquiries, claims resolution, and provider selection, improving member satisfaction scores by 15%.
  • Educated policyholders on healthcare coverage, benefits, and claim submission, reducing inbound escalations by 30%.
  • Resolved disputes and processed service requests efficiently, leading to a 25% reduction in claim-related complaints.
  • Maintained up-to-date knowledge of Medicaid, Medicare, and commercial health plans, ensuring accurate information delivery.

Front Desk Coordinator

MVHC
Zanesville, OH
09.2019 - 06.2021
  • Managed front desk operations, assisting over 75+ patients daily with appointment scheduling, registration, and insurance verification.
  • Performed high-volume data entry, maintaining a 99% accuracy rate for patient demographics, insurance details, and billing records.
  • Processed payment authorizations and insurance verifications, reducing billing errors by 25% and improving revenue cycle efficiency.
  • Ensured HIPAA compliance and patient confidentiality, contributing to a trusted healthcare environment.

Education

Associate of Applied Science - Social Services

Zane State College
Zanesville, OH
05-2010

Skills

  • Claims processing & Adjudication
  • Customer Service & Support
  • Data Entry & Accuracy
  • Payment Authorization & Verification
  • CMS 1500 & UB04 Forms
  • Policy & Compliance Knowledge
  • Problem-Solving & Critical Thinking
  • Communication & Active Listening
  • Healthcare & Insurance Systems
  • Time Management & Prioritization
  • Documentation & Reporting
  • Conflict Resolution

Education and Training

other

Timeline

Provider Claims Adjudicator

Molina Healthcare
02.2024 - Current

Healthcare Customer Support Specialist

Molina Healthcare
06.2021 - 02.2024

Front Desk Coordinator

MVHC
09.2019 - 06.2021

Associate of Applied Science - Social Services

Zane State College

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