Dedicated and results-driven professional with extensive experience in claims research, healthcare performance management, insurance, and client relations. Proven expertise in process improvement, data analysis, compliance, and customer service contributes to organizational growth and efficiency. Recognized for adaptability and problem-solving abilities, along with exceptional interpersonal skills that foster collaboration with teams and clients. Committed to tackling new challenges with enthusiasm while delivering impactful solutions that advance organizational objectives and drive success in fast-paced environments.
- Investigated and analyzed medical claims to establish recovery potential.
- Coordinated benefits for current and future claims, identifying and pursuing rebilling opportunities to maximize recovery.
- Maintained up-to-date profiles and accounts for patients, providers, and insurance carriers.
- Managed inbound and outbound calls, delivering clear communication and customer service to enhance client satisfaction.
- Completed compliance requirements, training, and acknowledgements within deadlines.
Analyzed data sets to identify trends and inform decision-making processes.
Collaborated with cross-functional teams to streamline research methodologies and improve outcomes.
Mentored junior researchers, enhancing team productivity and knowledge sharing.
Led project initiatives focused on optimizing research processes for greater efficiency.
Validated incoming data to check information accuracy and integrity while independently locating and correcting concerns.
Gathered and organized information for research purposes.
Performance Liaison
2 Years 1 Month
Steward Healthcare | 06.2019 - 07.2021
- Collaborated with physician practices to enhance quality, optimize risk adjustment, streamline workflows, and elevate patient experience.
- Developed training materials and facilitated on-site collaboration to advance provider and staff development.
- Evaluated workflows and implemented process improvements to enhance efficiency.
- Conducted data collection for appeals and compliance with coding/documentation standards to support accuracy and adherence.
- Conducted data collection for appeals, exclusions, and compliance with coding/documentation standards.
Consistently exceeded performance metrics while maintaining a high level of customer satisfaction.
Collaborated with team members to achieve performance goals, resulting in improved customer service metrics.
Order Specialist / Account Manager
1 Year 11 Months
Total Productive Staffing | 06.2017 - 05.2019
- Fostered positive customer relationships while managing purchase order transactions to ensure satisfaction and retention.
- Monitored, tracked, and resolved discrepancies to reduce costs and shipping delays.
- Delivered accurate PO confirmations, reports, and documentation to buyers and suppliers, facilitating smooth communication and order processing.
- Consolidated and reported key buyer data to support management decision-making and enhance strategic planning.
Processed customer orders with accuracy and efficiency, ensuring timely fulfillment.
Utilized order management systems to track shipments and resolve discrepancies.
Developed strong relationships with suppliers to enhance product availability.
Trained new team members on order processing protocols and best practices.
Led initiatives to improve customer satisfaction through enhanced communication and service delivery.
Ensured inventory accuracy by conducting regular audits, reconciling discrepancies, and updating database records accordingly.
Collaborated with sales team members to accurately forecast demand and plan for appropriate inventory levels.
Transformed customer service experience by consistently providing prompt responses to inquiries via email or phone calls ensuring all concerns are addressed immediately.
Insurance Claims Representative
3 Years 3 Months
Eberls Claims Service | 03.2014 - 06.2017
- Processed insurance claims, ensuring accuracy and adherence to regulatory standards.
- Resolved issues by communicating effectively with customers, attorneys, and public personnel.
- Maintained claim documentation and updated stakeholders on case status promptly.
- Identified opportunities for additional company program offerings.
Client Liaison
1 Year
Modis, Inc. | 01.2013 - 01.2014
- Investigated claims, negotiated settlements, and ensured policy compliance to facilitate timely resolutions.
- Investigated claims, negotiated settlements, and ensured compliance with policies.
- Coordinated with internal departments to efficiently resolve client inquiries and enhance service satisfaction.
- Generated end-of-day and certification reports to streamline loan processing and support operational accuracy.
Mortgage Specialist
1 Year 9 Months
Wingspan Portfolio Advisors | 02.2011 - 11.2012
- Supported customers in mortgage workout and retention options to enhance borrower satisfaction.
- Informed borrowers about foreclosure processes, repayment options, and eligibility to aid in informed decision-making.
- Ensured compliance with OCC, CFPB, and regulatory standards.
- Coordinated with CRMs, SPOCs, and negotiators to address customer needs effectively.