Jazmine Greenhill
Virginia Beach,VA
Summary
Experienced Claims Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 8+ years of experience and willingness to take on any challenge.
Overview
22
22
years of professional experience
Work History
Mgr Performance Audit
CarelonRx (Formerly Anthem)
03.2020 - Current
- Led a team of auditors in planning, executing, and reporting on performance audits for a diverse portfolio of clients
- Developed audit plans, including scope, objectives, and methodologies, to ensure thorough examination of processes and performance metrics
- Conducted in-depth data analysis to identify areas of inefficiency and opportunities for improvement within client organizations
- Collaborated with clients to understand their specific needs and concerns, fostering strong client relationships and trust
- Prepared detailed audit reports, highlighting findings and recommendations, and presented them to senior management and stakeholders
- Monitored the implementation of audit recommendations and provided guidance to clients on best practices for performance improvement
- Stayed current with industry standards and regulations to ensure audits were conducted in compliance with relevant guidelines.
- Collaborated with key personnel to verify data integrity and compliance with related regulatory guidelines and legal requirements.
- Led and contributed to process improvement projects by analyzing current workflows and identifying areas for optimization
- Collaborated with cross-functional teams to design and implement process improvements, ensuring alignment with business objectives
- Utilized data analysis and Lean Six Sigma methodologies to identify bottlenecks and reduce operational inefficiencies
- Compiled research data and gave professional presentations highlighting finds and recommended optimizations.
- Created and maintained process documentation, including flowcharts, standard operating procedures (SOPs), and training materials
- Conducted regular process audits to ensure compliance with standards and identify further improvement opportunities
- Facilitated training sessions for employees to ensure proper adoption of new processes and best practices.
Business Analyst II
Anthem Insurance Company
05.2019 - 03.2020
- Collaborated with stakeholders to gather and document business requirements for various projects, ensuring clear understanding of objectives and deliverables.
- Conducted in-depth data analysis, including trend analysis, forecasting, and performance measurement, to provide insights and support data-driven decision-making
- Created and maintained detailed documentation, including business requirement documents, user stories, and process flowcharts.
- Assisted in design and execution of test plans and test cases, ensuring successful implementation and validation of software applications
- Participated in cross-functional teams to support process improvement initiatives, identifying areas for optimization and enhancing operational efficiency
- Prepared and delivered clear and concise reports and presentations to communicate findings and recommendations to stakeholders and management.
- Performed gap analysis to identify areas of improvement.
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
- Conducted interviews with key business users to collect information on business processes and user requirements.
Process Expert
Anthem Insurance Company
09.2018 - 05.2019
- Conducted detailed process analysis, mapping out current workflows and documenting key performance indicators (KPIs)
- Collaborated with department heads to gather process improvement requirements and define project scopes
- Assisted in the design and execution of process improvement initiatives, resulting in streamlined operations and cost reductions
- Worked closely with IT teams to implement automation and technological solutions to enhance process efficiency
- Monitored the success of process improvement projects through data analysis and reporting, ensuring ongoing enhancements.
- Produced detailed and relevant reports for use in making business decisions.
- Gathered, documented, and modeled data to assess business trends.
Customer Care Rep II
Anthem Insurance Company
11.2015 - 08.2018
- Managed prior authorization requests, ensuring that prescriptions were processed accurately and efficiently
- Verified patient insurance coverage and communicated with insurance providers to secure approvals
- Assisted healthcare providers and patients in navigating prior authorization requirements and resolving any issues or discrepancies
- Maintained detailed records of prior authorization requests and approvals, ensuring compliance with regulations
- Collaborated with the pharmacy team to optimize processes and ensure timely prescription fulfillment
- Provided exceptional customer service by addressing inquiries, concerns, and issues related to prior authorizations and prescriptions
- Trained and mentored junior customer care representatives in prior authorization procedures.
- Researched issues and took appropriate action to resolve issues within turnaround time requirements and quality standards.
- Contacted third-party payors to obtain and confirm authorization for services and communicated necessary related clinical information.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
Claims Adjuster, Automobile and Casualty
USAA
04.2013 - 11.2015
- Examined claims forms and other records to determine insurance coverage.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Prepared summaries of damage, payments, and policy coverage.
- Researched and analyzed policy contracts to verify proper payment of claims.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Established relationships with clients and insurance companies to foster timely claims resolution.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Documented all investigation activity and presented reports to management.
Healthcare Specialist
US Army Reserve
02.2002 - 06.2010
- Administered and prescribed appropriate courses of treatment.
- Developed health plans for patients to improve overall health or recover from injuries and illnesses.
- Advised and educated patients regarding diet, hygiene and effective disease prevention methods.
- Educated clients and families about rights and responsibilities.
- Led multidisciplinary, continuous quality improvement program to improve patient outcomes.
- Provided both emergency and standard medical care to Army personnel by conducting verbal and physical exams and administering appropriate treatment.
- Took patient medical histories and vital signs as well as performed venipunctures, injections and diagnostic procedures and ancillary tests.
Education
Bachelor of Applied Science with a Specialization in Health Information Management -
Southern New Hampshire University
Hooksett, NH11.2025
Associate General Studies with a Specialization In Business Administration -
Tidewater Community College
Norfolk, VA01.2018
Skills
- Change management methodologies (eg, ADKAR, Prosci)
- Pharmacy and Medical Prior Authorization
- Medical Terminology to include ICD10 coding
- Process optimization
- Communication and presentation
- Clerical/Data Entry
- Process and data analysis, optimization and reporting
- Lean Six Sigma methodologies
- Corporate Policies and Procedures
- Critical Thinking
- Process documentation
- Customer Service
- Cross-functional collaboration
- Problem-solving
- Business process automation
- Credentialing Policies
- Software Application Testing
- Functional and Business Requirements
- User Acceptance Testing (UAT)
- Requirements Definition
Timeline
Mgr Performance Audit
CarelonRx (Formerly Anthem)
03.2020 - Current
Business Analyst II
Anthem Insurance Company
05.2019 - 03.2020
Process Expert
Anthem Insurance Company
09.2018 - 05.2019
Customer Care Rep II
Anthem Insurance Company
11.2015 - 08.2018
Claims Adjuster, Automobile and Casualty
USAA
04.2013 - 11.2015
Healthcare Specialist
US Army Reserve
02.2002 - 06.2010
Bachelor of Applied Science with a Specialization in Health Information Management -
Southern New Hampshire University
Associate General Studies with a Specialization In Business Administration -
Tidewater Community College