Hillary Moye
Raleigh,NC
Summary
Professional with significant experience in claims analysis and strong track record in team collaboration and achieving results. Skilled in risk assessment, claims processing, and regulatory compliance. Known for adaptability, problem-solving abilities, and clear communication. Prepared to contribute effectively to complex projects and support organizational goals.
Overview
10
10
years of professional experience
Work History
Senior Claims Analyst
Beacon Hill Staffing Group LLC.
Raleigh-Durham, NC
10.2025 - 01.2026
- Analyzed claims data to identify trends and discrepancies, improving accuracy of reporting.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently.
- Reviewed and evaluated claim submissions for compliance with company policies and regulations.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Analyze and audit claims adjudication results to determine if claims were accurately submitted and processed according to medical insurance guidelines.
- Analyze and audit claim attachments/medical documentation necessary to appropriately adjudicate a claim.
- Analyze, audit and take appropriate actions for claims delayed for adjudication due to rejection errors.
- Identify adjudication errors, provider billing errors, and the need for technical assistance.
- Provide training, education and technical assistance to provider agencies based on analysis or audit findings related to basic claim submission guidelines, denial management, system use and updates.
- Recognize and report suspected system issues or concerns to immediate supervisor for follow-up based on data analysis.
- Managed over 50 customer calls per day and Increased sales by 10%.
Revenue Cycle Financial Rep(Remote)
UNC Health
Chapel Hill, NC
10.2024 - 10.2025
- Respond to inbound calls regarding billing inquiries, payments, insurance, and financial assistance.
- Assist patients with making payments and setting up payment plans.
- Understanding EOBs and insurance billing.
- Requesting itemized bills, UB04/CMS 1500 forms and verifying coverage.
- Payroll deductions, refunds, and charity care applications.
- Estate-related billing and collections.
- May support MyUNCChart messages, written correspondence, and other self-pay workflows.
- Initiate outreach to provide resolution, collect on delinquent accounts and high-balance follow-ups.
- Investigate and resolve self-pay issues including SODCA, liability, and disputed balances.
- Support patient relations with escalated concerns, including charge validation and payment reconciliation.
- Document all interactions in CRM systems and follow up on unresolved issues.
- Maintain strict HIPAA compliance and patient confidentiality.
- Work assigned denial queues, including post-pay denials, underpayments, medical necessity, bundling, timely filing, and WC claims
- Prepare and submit appeals according to payer-specific playbooks
- Track claim status through final resolution and maintain clean, audible documentation
- Developed financial plans to optimize patient care funding and resource allocation.
- Analyzed financial data to identify trends and improve budget forecasting accuracy.
- Perform follow-ups with payers via phone, portals, and written correspondence
- Escalate complex or novel denial patterns to leadership as needed
Broker Accounts CSR
GFL
Raleigh, NC
09.2023 - 09.2024
- Provide excellent customer service and professionalism to all customers via in person, telephone or email
- Answer incoming and make outgoing telephone calls to customers, as well as, our Operations teams
- Serve as main contact and provide changes for Broker/Sales accounts
- Tower entry of service change for Broker/Sales accounts
- Track customer information, concerns, and enter data into database
- Provide contact research for all customer changes
- Download, distribute and answer all customer inquiries received via email
- Implement Broker/Sales account information to include any necessary correspondence, maintain hauler listing, location survey, pertinent notes, etc.
- Dispatch service orders to the branches
- Answer phones in rotation as needed
- Perform other duties and responsibilities as required or requested by management.
- Managed over 150/200 broker emails per day.
Account Manager(Remote)
10 Federal Storage, LLC
Raleigh, NC
02.2020 - 03.2023
- Responsible for managing tenant delinquencies, reservations/move in processing, escalated tenant concerns, ensuring insurance/protection plan on all units, and performing outbound calls and follow up communications to tenant concerns.
- Commitment to executing all sales and service programs to maximize sales opportunities and meet customer needs.
- Assist customers with renting storage units, understanding the lease terms, fees and insurance and completing lease agreements.
- Maintains account records that are accurate, up-to-date, and organized in a fashion that provides thorough documentation, increases efficiency and is understandable to others.
- Submit check requests for refunds, process waivers / voids within assigned approval tier.
- Submit and respond to assigned work orders.
- Monitor facility specific emails and respond in a timely manner.
- Follow up on reservations and audit move-ins for accurate processing.
- Communicate with tenants on escalated concerns and include necessary upper management.
- Accurately process account adjustments with approval.
- Assist with directing tenants to 3rd party claim processing.
- Report all incidents to the Senior Property Manager / District Manager and follow directions given for proper execution of resolutions.
- Developed and maintained strong client relationships to enhance customer satisfaction and retention.
- Analyzed account performance metrics to identify growth opportunities and drive revenue increases.
- Applies the appropriate treatment to resolve delinquency, and serves as a liaison between branch and clients.
- Managed client accounts, ensuring satisfaction through effective communication and relationship-building.
- Developed strategic account plans to align services with client objectives and foster long-term partnerships.
Claims Adjudicator
NC Department Of Commerce
Raleigh, NC
09.2018 - 02.2020
- Analyzed claims data to ensure compliance with regulatory standards and company policies.
- Reviewed and adjudicated complex insurance claims, identifying discrepancies and determining liability.
- Conducted audits of processed claims to identify trends and recommend process enhancements for quality assurance.
- Provided expert support during escalated claim disputes, facilitating resolution through thorough investigation and analysis.
- Provided exceptional customer service during interactions with policyholders, earning commendations from both clients and management.
- Supported team members in resolving challenging cases, sharing expertise to foster professional growth among colleagues.
- Managed a caseload of complex claims, ensuring proper handling and timely resolution for optimal outcomes.
- Executed claims processing, while generating increased revenue.
- Expedited payment disbursements by efficiently managing claim settlements and documentation requirements.
- Assisted management in updating internal policies related to claims adjudication processes for increased efficiency and effectiveness.
- Managed over 50 customer calls and 100 emails per day.
Senior Claims Analyst
NThrive
Raleigh, NC
11.2015 - 08.2018
- Requesting itemized bills, UB04/CMS 1500 forms and verifying coverage.
- Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits.
- Ability to handle potentially high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits.
- Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information.
- Pay all covered claims accurately and timely.
- Adhere to standard timeframes for processing mail, tasks and outliers.
- Conducts in-depth pre-existing conditions or contestable investigations if applicable.
- Work assigned denial queues, including post-pay denials, underpayments, medical necessity, bundling, timely filing, and WC claims
- Track claim status through final resolution and maintain clean, audible documentation
- Perform follow-ups with payers via phone, portals, and written correspondence
- Escalate complex or novel denial patterns to leadership as needed
- Analyzed complex claims data to identify trends and discrepancies, enhancing accuracy of claim resolutions.
- Led cross-functional teams in the development of process improvements, increasing operational efficiency by streamlining workflows.
Education
High School Diploma -
William G Enloe High School
Raleigh, NC07.1997
Skills
- Claims processing efficiency
- Strong negotiation skills
- Critical thinking
- Professionalism and integrity
- Customer service
- Payment plans
- Relationship building
- Account management
- Teamwork and collaboration
- Client relations
Timeline
Senior Claims Analyst
Beacon Hill Staffing Group LLC.
10.2025 - 01.2026
Revenue Cycle Financial Rep(Remote)
UNC Health
10.2024 - 10.2025
Broker Accounts CSR
GFL
09.2023 - 09.2024
Account Manager(Remote)
10 Federal Storage, LLC
02.2020 - 03.2023
Claims Adjudicator
NC Department Of Commerce
09.2018 - 02.2020
Senior Claims Analyst
NThrive
11.2015 - 08.2018
High School Diploma -
William G Enloe High School