Jill Albright
The Villages
Summary
Insurance Claims Specialist skilled in optimizing claims processing efficiencies at Blue Cross Blue Shield IL. Demonstrated expertise in Medicare, Medicaid, and HMO/PPO lines, resulting in significant improvements in service delivery. Strong organizational abilities and analytical skills enhance team collaboration and operational performance. Committed to further advancing operational excellence within the insurance sector.
Overview
27
27
years of professional experience
Work History
Claims Reporting Analyst
Guidehealth
The Villages
06.2023 - Current
- Handled referral-based queries through proficient telephone assistance.
- Managed pre-certification requests accurately.
- Produced periodic reports to assess advancement towards company targets.
- Managed intricate and valuable claims efficiently.
- Monitored claims inventory to ensure achievement of established goals.
Claims Coordinator
Blue Cross Blue Shield IL
Rockford
03.2013 - 04.2023
- Mentor and Training: Promote success to our claims processing team through mentorship, continuous growth, and accessible resources
- Project management and problem solving: Juggle multiple projects at a time, time management to meet deadlines, and quick thinking to solve complex situations
- RTB, Dashboard, and MLE testing and troubleshooting prior to system release
- Ideation, Implementation, and Growth of Enhancements: Troubleshoot system needs and work with Technical Operations and IT to implement system enhancements
- 3rd Party Interactions: Work with multiple areas across the division and lines of business to resolve complex situations, including international work with business partners
Customer Advocate Specialist
Blue Cross Blue Shield IL
Rockford
01.2011 - 03.2013
- Customer and Technical Service: Handling escalated customers, resolving high complex claims
- Mentor and Training: Worked closely with supervisor in developing and maintaining training materials
- Lead Support: Resolve complex claim situations and support current and new employees to be successful in their role
- Responded to inquiries to troubleshoot claims adjudication issues
- Collaborating: Established rapport with various internal departments to gather data on benefit agreements and improve customer experience
Auditor
Blue Cross Blue Shield IL
Rockford
01.2001 - 01.2011
- Product Performance: Identified performance gaps and provided regular feedback to management on performance improvement opportunities
- Product Performance: Successfully provided valuable feedback on procedures and training for the professional development of employees
Customer Advocate
Blue Cross Blue Shield IL
Rockford
02.1998 - 01.2001
- Customer Service: Taking inbound calls, resolving customers’ inquiries while maintaining high closure rate and after call work time
- Project Lead: Oxford Insurance- this was an insurance that HCSC bought and I became the lead on their run out claims
Education
Northeast Missouri State
Kirksville, MOSkills
- Insurance Claims Knowledge
- Medicare and Medicaid knowledge
- HMO and PPO lines of business
- Organizational skills
- Time management
- Prioritizing skills
- Decision-making
- Team collaboration
- Analytical skills
- Oral skills
- Written skills
- Presentation skills
- Word
- Excel
- PowerPoint
- SharePoint
- Outlook
Timeline
Claims Reporting Analyst
Guidehealth
06.2023 - Current
Claims Coordinator
Blue Cross Blue Shield IL
03.2013 - 04.2023
Customer Advocate Specialist
Blue Cross Blue Shield IL
01.2011 - 03.2013
Auditor
Blue Cross Blue Shield IL
01.2001 - 01.2011
Customer Advocate
Blue Cross Blue Shield IL
02.1998 - 01.2001
Northeast Missouri State
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