Summary
Overview
Work History
Education
Skills
Timeline
Generic

JEREMY M. HAU

Waukesha,WI

Summary

Results-driven claims management professional prepared for this role with strong background in assessing and processing claims, resolving disputes, and ensuring compliance with regulations. Skilled in risk analysis, negotiation, and policy interpretation, with proven track record of fostering team collaboration and adapting to changing needs. Known for reliability, effective communication, and focus on achieving optimal outcomes.

Overview

21
21
years of professional experience

Work History

Claims Manager

Community Care
04.2022 - Current
  • Manage a team of 20 overseeing the provider hotline, claims team processing Medicare and Medicaid claims, supervisors, claims auditors/quality, appeals and subrogation
  • Collaborated with other departments to improve overall organizational effectiveness in addressing client needs.
  • Enhanced provider satisfaction with timely and accurate claims resolutions.
  • Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
  • Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes.
  • Improved claims processing efficiency by implementing streamlined workflow procedures.
  • Negotiated settlements with claimants, achieving fair outcomes while controlling costs.
  • Mentored new hires on company policies/procedures enabling them to quickly become proficient in managing claims.
  • Analyzed claims data, identifying trends and areas for improvement in processes and policies.
  • Oversaw regular audits of claims to ensuring accuracy in reserve amounts and adherence to established guidelines.

Claims Analyst/Auditor

Community Care
06.2016 - 04.2022
  • Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for organizational recommendation to establish efficiencies.
  • Analyzed large amounts of data to find patterns of fraudulent billing recovering over 1 million dollars.
  • Assisted in recovering funds through diligent identification of overpaid or incorrectly paid claims.
  • Created various Microsoft Access reports to assist with pulling metrics data and cost containment opportunities.
  • Organizational contact for claims audits conduct by external auditors.

Claims Supervisor

Community Care
03.2012 - 06.2016
  • Managed and supervised 16 team members.
  • Managed adjustment, suspend and data entry claim inventories.
  • Monitor call quality and service levels.
  • Resolve non-routine business-related concerns and escalated provider issues
  • Compile quarterly reporting for Wisconsin Department of Health Services
  • Assisted with the implementation of a new claims processing system
  • Developed workflow documentation and training materials for new claims processing system
  • Monitored team performance, enforcing compliance with corporate claims processes and procedures.

Provider Education Specialist

Community Care
02.2011 - 04.2012
  • Provided education and training to providers on proper claim submission.
  • Resolve escalated claim and provider contract issues.
  • Assisted with training and development of a provider claim portal.

Frontline Leader Claims Review Team

Humana
02.2010 - 11.2010
  • Managed and Supervised 17 team members.
  • Over saw team conducting thorough investigations on material misrepresentation cases, ensuring timely resolution and minimizing financial impact.
  • Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.

Customer Service/Claims Processor

Humana
01.2005 - 09.2010
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
  • Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.

Frontline Leader Customer Care and High Dollar Claims

Humana
03.2008 - 02.2010
  • Oversaw day-to-day activities of ten employees reviewing and processing high dollar claims.
  • Led cross-functional teams to achieve company-wide goals, fostering a culture of collaboration and innovation.
  • Increased team productivity by streamlining communication and implementing effective project management strategies.
  • Monitored performance metrics regularly, identifying areas for improvement and implementing corrective measures accordingly.

Grievance and Appeals Specialist

Humana
02.2007 - 03.2008
  • Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
  • Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines and heavy caseloads.
  • Worked with department and medical directors to make decisions regarding member’s policies
  • Conducted comprehensive training sessions for new hires on proper procedures for processing claims and managing appeals caseloads.
  • Created, composed and maintained appeal response templates.

Customer Care Specialist/Claims Processor

Humana
03.2005 - 02.2007
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Managed high claim caseloads effectively while maintaining accuracy and timeliness in claims processing tasks.
  • Took ownership of customers issues to follow problems through to resolution.
  • Provided customers with detailed information on claim status and policy benefits.

Internship

Brown County Housing Authority
01.2004 - 01.2005
  • Revised and updated Greater Green Bay Fair Housing Guide
  • Completed analysis of 3,200 recipients of Housing Choice Voucher Program
  • Presented program outcomes to nonprofit organizations and Brown County advisory boards

Education

B.S. - Public Administration

University of Wisconsin Green Bay
Green Bay, WI
05.2004

B.A. - History

University of Wisconsin Green Bay
Green Bay, WI
05.2004

Skills

  • Claims analysis
  • Claims investigation and research
  • Claims auditing
  • Team management
  • Performance monitoring
  • Customer expectations management
  • Problem-solving
  • Data cleaning

Timeline

Claims Manager

Community Care
04.2022 - Current

Claims Analyst/Auditor

Community Care
06.2016 - 04.2022

Claims Supervisor

Community Care
03.2012 - 06.2016

Provider Education Specialist

Community Care
02.2011 - 04.2012

Frontline Leader Claims Review Team

Humana
02.2010 - 11.2010

Frontline Leader Customer Care and High Dollar Claims

Humana
03.2008 - 02.2010

Grievance and Appeals Specialist

Humana
02.2007 - 03.2008

Customer Care Specialist/Claims Processor

Humana
03.2005 - 02.2007

Customer Service/Claims Processor

Humana
01.2005 - 09.2010

Internship

Brown County Housing Authority
01.2004 - 01.2005

B.S. - Public Administration

University of Wisconsin Green Bay

B.A. - History

University of Wisconsin Green Bay
JEREMY M. HAU