Holly Braddy
Amesbury,MA
Summary
Detail-oriented Senior Stop Loss Claims Analyst with expertise in claims analysis, data auditing, and effective communication. Proven ability to resolve complex inquiries and ensure compliance with regulatory standards.
Overview
8
8
years of professional experience
Work History
Senior Stop Loss Claims Analyst
Voya Financial
New York, NY
08.2021 - Current
- Analyzed claims data to identify trends and discrepancies in processing.
- Collaborated with cross-functional teams to resolve customer inquiries efficiently.
- Reviewed documentation to ensure compliance with regulatory standards and policies.
- Conducted audits on claims files for accuracy and completeness.
- Communicated effectively with clients regarding claim status and requirements.
- Conducted investigations to gather evidence for claims resolution, enhancing accuracy and compliance.
- Verified documents to ensure accuracy of information provided by customers.
- Investigated claim and settlement deals and reviewed coverage determinations.
- Maintained accurate records of all claim activities in accordance with company policies.
- Followed all company procedures to keep data confidential.
- Reviewed customer claims, identified discrepancies, and determined course of action to facilitate timely resolutions.
- Assessed medical records for coverage eligibility and benefit accuracy.
- Participated in meetings with internal departments and external vendors to discuss disputed claims.
- Managed escalated cases involving high-value claims and multiple parties, ensuring effective resolution and customer satisfaction.
- Researched applicable laws and regulations related to insurance policies and procedures.
- Advised customers on filing requirements, documentation needed, and other matters pertaining to their claims.
- Reviewed and processed insurance claims following company procedures and industry regulations.
Senior Stop Loss Claims Analyst
Davies Group/ Northshore International Insurance
Danvers , ME
05.2018 - 2021
- Conducted audits on claims files for accuracy and completeness.
- Managed workload effectively to ensure timely processing of claims within designated deadlines.
- Documented all claims activities clearly and concisely in the claims management system.
- Analyzed claims data to determine coverage and liability, ensuring accurate decision-making.
Education
High School Diploma -
Masconomet Regional
Topsfield06-1980
Skills
- Claims analysis
- Coverage determination
- Claims documentation
- Claim investigation
- Data auditing
- Proficient in Microsoft, Excel, ESL
- Attention to detail
- Decision-making skills
- Customer relationship management
- Conflict resolution
- Effective communication
- Interpersonal communication
Timeline
Senior Stop Loss Claims Analyst
Voya Financial
08.2021 - Current
Senior Stop Loss Claims Analyst
Davies Group/ Northshore International Insurance
05.2018 - 2021
High School Diploma -
Masconomet Regional