Joanne Cargin
ARVERNE,NY
Summary
Professional with significant experience in claims analysis and strong track record in claims processing efficiency and implementing fraud detection measures. Bilingual in English/Spanish, I excel in team leadership and critical thinking, fostering collaboration to achieve operational goals and improve compliance standards. Proven track record in training development and performance optimization.
Overview
22
22
years of professional experience
Work History
Senior Claims Analyst
Emblem Health Plan
New York, NY
07.2021 - 06.2026
- Analyzed complex claims to ensure compliance with regulatory requirements and company policies.
- Collaborated with cross-functional teams to streamline claims processing workflows and reduce turnaround times.
- Developed training materials for junior analysts, enhancing team knowledge and effectiveness in claims resolution.
- Conducted audits on claim submissions, identifying discrepancies and implementing corrective action plans.
- Maintained up-to-date knowledge of industry trends and regulatory changes, applying insights to enhance claim processing effectiveness.
- Implemented effective fraud detection measures, resulting in the identification and prevention of fraudulent claims activities.
Training Team Lead
MetroPlus
Newark, NY
04.2018 - 06.2021
- Led cross-functional teams to enhance operational efficiency and improve project outcomes.
- Developed training manuals for new staff, fostering skill development and team cohesion.
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
- Monitored team performance metrics, ensuring alignment with organizational goals and standards.
- Trained new team members by relaying information on company procedures and safety requirements.
- Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
Quality Assurance Training Specialist
MetroPlus
Newark, NY
01.2015 - 04.2018
- Developed customized training materials including presentations, job aids, and facilitator guides for effective knowledge transfer.
- Facilitated workshops and seminars, promoting engagement and interactive learning experiences for staff members.
- Evaluated training effectiveness through feedback analysis, ensuring continuous improvement of educational offerings.
- Collaborated with departmental leaders to identify training needs and tailor programs accordingly for diverse teams.
- Streamlined onboarding process for new hires, resulting in reduced time to productivity.
- Established a mentorship program to facilitate knowledge sharing between experienced employees and new hires, enhancing overall team performance.
Senior Claims Examiner
MetroPlus
Newark, NY
01.2014 - 01.2015
- Led claims adjudication process, ensuring compliance with regulatory standards and company policies.
- Process complex, difficult and non-routine claims for multiple lines of business.
- Streamlined claims processing workflows, reducing turnaround times and enhancing operational efficiency.
- Provide audit statistics to lead auditor, participate in quality projects as required by management.
Quality Assurance Training Specialist
MetroPlus
Newark, NY
03.2012 - 12.2013
- Assist and administer all customer services and FE Integrity trainings for staff.
- assist with the creation of all new training materials.
- Assist with refresher trainings.
- Complete live and back-end monitoring for the call center.
- Document all calls monitored on Silent Monitoring
Quality Analyst
MetroPlus
Newark, NY
05.2010 - 03.2012
- Developed and executed test plans to ensure software quality and functionality.
- Analyzed defects and coordinated with development teams for timely resolution.
- Implemented automated testing tools to enhance testing efficiency and accuracy.
- Conducted root cause analysis to identify process improvements in quality assurance workflows for the call center.
- Recommended changes and corrections to developers for optimal software performance and usability.
Customer Service Representative
MetroPlus
Newark, NY
07.2004 - 05.2010
- Handle a high volume of incoming calls, faxes, verify eligibility for providers/ members on eMedNYand TXEN System
- Resolved customer inquiries efficiently through phone and email communication.
- Coordinated with internal departments to ensure timely resolution of service issues.
- Developed training materials for new staff on customer service protocols.
- Led initiatives to enhance customer satisfaction and retention rates.
- Recorded notes in MACESS
- Provide new member orientation
Education
Fashion Illustration
Fashion Institute of Technology
New York, NYDelaware Valley Job Corps
Callicoon, NY09-1997
Skills
- Bilingual in English/ Spanish
- Claims processing efficiency
- Strong negotiation skills
- Critical thinking
- Professionalism and integrity
- Team leadership experience
- Teamwork and collaboration
- Multitasking
Timeline
Senior Claims Analyst
Emblem Health Plan
07.2021 - 06.2026
Training Team Lead
MetroPlus
04.2018 - 06.2021
Quality Assurance Training Specialist
MetroPlus
01.2015 - 04.2018
Senior Claims Examiner
MetroPlus
01.2014 - 01.2015
Quality Assurance Training Specialist
MetroPlus
03.2012 - 12.2013
Quality Analyst
MetroPlus
05.2010 - 03.2012
Customer Service Representative
MetroPlus
07.2004 - 05.2010
Fashion Illustration
Fashion Institute of Technology
Delaware Valley Job Corps