Jeff Brown
Senior Claims Associate
Fortson,GA
Summary
Successful at developing and deepening customer relations and working well with everyone involved in investigating and adjudicating claims. In-depth understanding of procedures and compliance.
Overview
23
23
years of professional experience
20
20
years of post-secondary education
Work History
Senior Claims Representative (SWAT team)
Anthem, Inc.
1 2024
- Promoted January of 2024 to a specialized team that moves to different contracts that are in need of help
- A high functioning employee that demonstrates the ability to quickly learn new contracts, policies, and systems
- A proven capability to provide top notch quality while maintaining a high performance level.
Senior Claims Representative
Anthem, Inc.
01.2013 - 01.2024
- A passionate, goal-oriented, and a highly accomplished claims professional
- Thrived while concurrently handling multiple groups' policies and their claims
- A proven track record in claims investigations, patient and provider liability determinations, and effectively and efficiently processing claims
- Achieved goals and policies for the Department to easily read the new benefits for our client's medical policies and how to apply them to claims
- Learned how to help lead teams even when not being a direct leader, which requires a lot of influence and tenacity
- Directs the new employees training to help ensure they get the one on one attention needed for questions and any help they might need to better understand systems, benefits and processes
- Helped lead team meetings and breakout sessions to go over any and all system issues and cover all updates to our client's medical policy.
Claims Representative II - III
Anthem, Inc.
01.2001 - 01.2013
- Began career in Customer Service to help learn products, company culture and about the customer experience
- Listening attentively to the caller needs to ensure a positive customer experience
- Excelled within a service oriented company and strove for quick resolution of any customer complaints
- Progressed to Claims Representative after success in Customer Service role
- During this long tenure with Anthem, was promoted from level one to a level three representative
- Each level provided more responsibilities, including leading meetings and training new employees
- Updated the team when new contracts and policies were available
- Created web design, excel spreadsheets, and power points for daily team meetings.
Education
Bachelor of Science - Computer And Information Systems Security
Columbus State University
Columbus, GA 05.2001 - 05.2021
Skills
Java
Python
MySQL
Windows
Visual Studio
MS Office
Cobol
C
IOS
VirtualBox
Communication
Time Management
Multi-Tasking
Efficiency
Problem Solving
Interpersonal Skills
Collaboration
Analytical
Java
Python
MySQL
Windows
Visual Studio
MS Office
Cobol
C
IOS
VirtualBox
Claims Investigation
Claims analysis
Claims Processing
Microsoft Office
Documentation Review
Decision-Making
Team Collaboration
Data Analysis
Flexible Schedule
Customer Service
Problem-Solving
Policy understanding
Database Management
Policy Knowledge
Coverage Determination
Coverage assessments
Teamwork and Collaboration
Excellent administrative abilities
Problem-solving abilities
Data Entry
Documentation processing
Multitasking Abilities
Excellent Communication
Self Motivation
Time management abilities
Adaptability and Flexibility
Critical Thinking
Effective Communication
Active Listening
Organizing and Prioritizing Work
Policy analysis
Team building
Attention to Detail
Problem-solving aptitude
Analytical Thinking
Information Verification
Collaborative relationships
Claims adjustment
Analytical Skills
Goal Setting
Prior authorization processing
Medical Terminology
Data Integrity
Business Correspondence
Payment and Investigation Escalations
Data Entry Software
References
Available upon request
Timeline
Senior Claims Representative
Anthem, Inc.
01.2013 - 01.2024
Bachelor of Science - Computer And Information Systems Security
Columbus State University
05.2001 - 05.2021
Claims Representative II - III
Anthem, Inc.
01.2001 - 01.2013
Senior Claims Representative (SWAT team)
Anthem, Inc.
1 2024