Jessica Fick

• Processed adjustments/ pdrs for senior, commercial and Medi-cal members
• Reduced errors in claim assessments by meticulously reviewing documentation and policy terms.
• Consistently met or exceeded performance expectations, demonstrating commitment to providing top-quality service to clients.
• Review cap deduct/ quarterly reports for both health plans and finance.
• Assist in training in service now program for all inquiries both internal and external.
• Worked closely with health plans to resolve both provider and member disputes.

•Processed claims for senior lines of business.

•Processed both hospital and professional claims.

•Reviewed hospital contracts.

•Cob applications

• Processed claims efficiently, ensuring compliance with company policies and regulatory standards.
• Reviewed documentation for accuracy, identifying discrepancies to facilitate timely resolutions.
• Maintained detailed records of claims activities, ensuring data integrity for audit purposes.
• Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
• Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
• Managed workload and priorities to meet claims processing meet deadlines.
• Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
• Identified fraudulent claims through thorough investigation and documentation of findings.
• Identified and reported potential fraud or abuse related to claims to protect system's integrity.
• Contributed to the development and implementation of new procedures, policies, or guidelines that improved claim processing efficiency across the organization.