JAMIE LAVALLEY
Hudson,NH
Summary
Experienced medical claims processor and auditor with a strong track record in ensuring claim accuracy. Detail-oriented professional excelling in effective communication and project management. Demonstrated ability to efficiently handle multiple tasks in fast-paced environments. Proactive approach in identifying and addressing issues, focusing on optimizing processes and supporting team objectives.
Overview
22
22
years of professional experience
Work History
Account Installation Senior Representative
Cigna
10.2024 - Current
- Attain and develop proficiencies with end-to-end processes and funding types, including , Vista, DPL, technical processes, product knowledge, state and federal mandates, and all matrix partner interactions.
- Analyze and code benefits in the system to ensure they are in compliance with legislation.
- High Volume, Quality & Accuracy driven, Production Environment
Quality Review & Audit/Medical Claims Processor
Cigna
06.2017 - 10.2024
- Responsible for reviewing and auditing complex claims, ensuring accuracy and compliance.
- Paid or denied medical claims based upon established claims processing criteria.
- Managed large volume of medical claims on daily basis.
- Proved successful working within tight deadlines and a fast-paced environment.
- Identified issues, analyzed information and provided solutions to problems.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
Emergency Room/Laboratory
Southern New Hampshire Health Systems
01.2009 - 05.2017
- Conducted patient registration, specimen processing, and phlebotomy duties at Southern New Hampshire Health.
- Ensured accurate patient identification and distribution of specimens to appropriate departments.
- Developed strong skills in specimen handling, patient care, and medical terminology.
Loss Prevention Manager
Kohl's
06.2003 - 01.2009
- Internal theft investigation of employees
- Apprehension of shoplifters, as well as processing them for arrest if applicable
- Completed arrest warrants, and attended trials when subpoenaed
Education
Associate of Science - Corrections, Probation & Parole
HESSER COLLEGE
Nashua, NH01.2006
Associate of Science - Law Enforcement
Hesser College
New Hampshire01-2006
Skills
- HIPAA
- Insurance eligibility verification
- Quality verification processes
- Compliance management
- Legislation Mandates
Timeline
Account Installation Senior Representative
Cigna
10.2024 - Current
Quality Review & Audit/Medical Claims Processor
Cigna
06.2017 - 10.2024
Emergency Room/Laboratory
Southern New Hampshire Health Systems
01.2009 - 05.2017
Loss Prevention Manager
Kohl's
06.2003 - 01.2009
Associate of Science - Corrections, Probation & Parole
HESSER COLLEGE
Associate of Science - Law Enforcement
Hesser College
Similar Profiles
Micheal D. OvuedeMicheal D. Ovuede
Sr. GRC Consultant at CignaSr. GRC Consultant at Cigna
Kristina Nestor WalkerKristina Nestor Walker
HCC Coder and Quality Review Audit Analyst at CignaHCC Coder and Quality Review Audit Analyst at Cigna
Noël PotterNoël Potter
Dental Claims Processor at CignaDental Claims Processor at Cigna