Holly Joiner
Medical Claims Analyst
Dallas,TX
Summary
Results-driven Claims Analyst with a strong focus on claims processing, policy interpretation, and team training. Proven ability to enhance processing efficiency and support audits, ensuring compliance and accuracy.
Overview
15
15
years of professional experience
Work History
Claims Analyst
Medix Staffing
Oak Brook, IL
05.2025 - Current
- Analyzed claims data to identify trends and discrepancies.
- Processed and reviewed insurance claims for accuracy and compliance.
- Collaborated with team members to resolve claim-related inquiries efficiently.
- Utilized claims management software to track claim statuses and updates.
- Analyzed medical claims for accuracy and compliance with regulations
- Processed claim submissions using industry-standard software tools
- Assisted in identifying trends in claim denials for process improvement
- Maintained organized records of processed claims and communications
- Supported audits by preparing necessary documentation and reports
- Enhanced claim processing efficiency by implementing automated workflows and streamlining procedures.
- Modified, updated and processed existing policies.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Calculated adjustments, premiums and refunds.
Claims Analyst
Association Healthcare Management
Houston, TX
01.2023 - 01.2025
- Supported the implementation of process improvements for claims handling.
- Assisted in preparing reports on claims performance and outcomes.
- Communicated effectively with clients to clarify claim details and requirements.
- Maintained organized records of claims documentation for auditing purposes.
- Collaborated with healthcare providers to resolve discrepancies in claims
- Reviewed documentation to ensure adherence to payer policies and guidelines
- Communicated effectively with team members to streamline claims processing
- Conducted comprehensive audits to identify inconsistencies and irregularities in medical claims data.
- Participated in cross-functional teams to develop strategies for improving overall department performance metrics.
Claims Examiner
WebTPA
Irving, TX
10.2021 - 02.2023
- Evaluated and processed insurance claims for accuracy and compliance with company policies.
- Conducted thorough investigations to assess claim validity and detect potential fraud.
- Collaborated with healthcare providers to obtain necessary documentation for claim processing.
- Utilized claims management software to track and manage claim statuses efficiently.
- Reviewed and processed medical claims for accuracy and compliance with policies.
- Analyzed claim data to identify discrepancies and resolve issues efficiently.
Claims Technician
Health Care Service Corporation, HCSC
Abilene, TX
05.2011 - 07.2021
- Processed and evaluated claims to ensure compliance with company policies and regulatory standards.
- Analyzed claim documentation for accuracy, identifying discrepancies and facilitating timely resolution.
- Collaborated with internal departments to address claim-related inquiries and enhance customer satisfaction.
- Implemented workflow improvements that increased efficiency in claims processing operations.
- Collaborated with providers to clarify information and expedite claims resolution.
- Ensured timely submission of claims, enhancing turnaround times for reimbursements.
Education
GED -
Texas Education Agency
Abilene, TX01-2003
Skills
- Claims
- Claims analysis
- Interpersonal and written communication
- Policy interpretation
- Claim investigation
- Claims review
- Claims processing
- MS office
- Critical thinking
- Computer skills
- Team Training
- Claim form analysis
- Benefits review
- Healthcare common procedures coding system (HCPCS)
Timeline
Claims Analyst
Medix Staffing
05.2025 - Current
Claims Analyst
Association Healthcare Management
01.2023 - 01.2025
Claims Examiner
WebTPA
10.2021 - 02.2023
Claims Technician
Health Care Service Corporation, HCSC
05.2011 - 07.2021
GED -
Texas Education Agency