Jena Vahdatpour
SANFORD,FL
Summary
Detail-oriented individual with exceptional communication and project management skills. Demonstrated ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for proactive problem-solving, optimizing processes, and supporting team objectives.
Overview
12
12
years of professional experience
Work History
Claims Operations Analyst I
CNA Insurance Companies/ Best Claims Solutions
07.2024 - Current
- Reviewed system for frequent technical issues, employing troubleshooting techniques for resolution.
- Assessed operational performance to identify areas for improvement.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Identified and resolved discrepancies and errors.
- Researched and resolved billing discrepancies to enable accurate billing.
- Audited and corrected billing and posting documents for accuracy.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Researched CPT and ICD-9 coding, payer contracts, remittances, and explanation of benefits (EOB) statements, discrepancies for compliance and reimbursement accuracy.
- Located errors and promptly refiled rejected claims.
- Identified and supported business process requirements and development needs.
- Commerical Level- Property, General & Professional Liability, Auto, and Workman Comp Claims Experience
Claims Assistant
IWC Group
10.2023 - 04.2024
- Reviewing and entering financial information such as reserve information, processing daily payroll indemnity checks, issuing payments from defense counsel, experts, and settlement payments, over 100 processed daily.
- Verifying and analyzing data used in settlement claims to ensure that claims and settlements are made by corporate, State, and client policy and procedure.
- Initiation and follow-up for Workers' Compensation procedures and treatment authorizations.
- Report preparation and completion for clients and internal analysis based on medical records and bills
- Complete specialized projects assigned that include legal research
- Assisted over 6 adjusters in gathering critical information for accurate evaluations of loss events and damage estimates
- Prepared files, letters, and notices
- Schedule appointments and collect necessary information for data entry, treatment, and billing purposes
Insurance Operations Processor
Oscar Health
11.2021 - 07.2023
- Analyze data for claims adjudication to ensure accuracy, using this data to make decisions daily.
- Conduct training classes for various life cycles of the claims process with an emphasis on provider disputes, billing, and eligibility.
- Develop visual workflow materials for training classes.
- Provide one-on-one coaching and peer support for both starting and on-the-job performance.
- Auditing and scheduling staff duties for over 25 employees.
- Check monthly reports and analyze billing data to identify trends and discrepancies.
- Prepare itemized statements, bills, and invoices, and record amounts due for items purchased and services rendered.
- Developed and implemented effective billing processes to improve accuracy and efficiency.
- Collaborate with business partners to resolve, improve, and implement solutions.
Medical Claims Adjuster
Progressive Insurance
03.2021 - 08.2021
- Interviewed witnesses, customers, attorneys, providers, and claimants.
- Documented injury-related treatment, lost wages, and other expense histories to ensure an accurate claim file.
- Utilized IME and Peer Review processes when it was appropriate.
- Authorized payments to providers and eligible parties based on analyzed medical bills and records, lost wages, and other expense claims submitted.
- Researched and interpreted injury-related statutory provisions and case law; examined points of impact and extent of damage relative to the mechanism of injury claimed; ran reports for prior injury information.
- Obtained proper release documentation and statements; acquired detailed medical reports, medical bills, wages, and other expense information and conducted detailed research relating to damages submitted for payment.
- Used medical billing knowledge to understand and effectively interpret payer contracts, remittances, and explanation of benefits (EOB) statements.
- Directed claims negotiations within allowable limit of $10,000 and supported successful litigations for advanced issues.
Personal Lines Underwriter
Farmers Insurance
06.2019 - 01.2020
- Recognized problems, issues, and improvement possibilities.
- Summarize information and make recommendations based on policy guidelines.
- Balanced risk relative to return to make effective and acceptable underwriting decisions.
- Responsible for accurate premium registration and invoicing, coding, pricing, and commission calculations for insurance agents.
- Strategically reviewed files, and collected missing documents, signatures, and all requirements to complete and bind a policy.
- Collaborated with internal departments to develop and maintain underwriting standards
- Handled over 80 customer interactions daily.
Auto Product Specialist
AAA - Auto Club Group Inc
07.2012 - 05.2019
- In a leadership and quality role, managed and conducted new hire on-the-job training classes of 15-20 in size.
- Scored and monitored new hire and complaint calls, providing feedback on de-escalation techniques and customer service etiquette.
- Managed Damage, Service Repair Shop, Inter-club, claims/complaints, providing end solutions with business needs staying intact.
- Front Line In-Take Claim assistance also provides support through the claim process for both the client and vendors.
- Provided technical support assistance for the vast contractor network for various states.
- Quickly and efficiently manage complex internal and external complaints with a member complaints resolution rate of 99.9% annually.
- Workforce Management, reviewing call queues for average handle time and availability.
- Monitored emergency dispatch board in a leadership capacity, delegating emergency actions as required, and ensuring emergency arrival times.
Education
GED -
Seminole State College of Florida
Sanford, FLSkills
- Microsoft Office
- Google Suites
- Tracking Spreadsheets
- JIRA
- Project Management
- CRM
- Data Collection
- Leadership
- HIPAA Compliance
- Medical Billing
- Medical Terminology
- Legal Research
- Time Management
- Operational efficiency
Timeline
Claims Operations Analyst I
CNA Insurance Companies/ Best Claims Solutions
07.2024 - Current
Claims Assistant
IWC Group
10.2023 - 04.2024
Insurance Operations Processor
Oscar Health
11.2021 - 07.2023
Medical Claims Adjuster
Progressive Insurance
03.2021 - 08.2021
Personal Lines Underwriter
Farmers Insurance
06.2019 - 01.2020
Auto Product Specialist
AAA - Auto Club Group Inc
07.2012 - 05.2019
GED -
Seminole State College of Florida
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