Joyce McGregor
Charlotte,NC
Summary
Dedicated and detail-oriented claim resolution specialist with 8 years of experience in processing, reviewing, and resolving insurance and billing claims. Proven track record of improving claim resolution time and customer satisfaction through strong analytical and communication skills. Skilled in navigating complex claim systems, interpreting policy guidelines, and ensuring compliance with regulatory standards.
Overview
8
8
years of professional experience
Work History
Claim Resolution Specialist
CalOptima Health
10.2017 - Current
- Resolved over 95% of incoming claim issues within established timeframes, contributing to a 20% increase in team efficiency.
- Analyzed and corrected claim errors to ensure proper adjudication and reimbursement.
- Served as a liaison between providers, members, and internal departments to clarify policy benefits and resolve disputes.
- Reduced denial rates by identifying common claim errors and conducting training sessions for billing staff.
- Explained policy coverage, liability and denials to policyholders, lawyers, and other involved parties.
- Collected information about rejected claims and developed effective solutions.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Follows up with providers as needed.
Education
HS Diploma -
Lindenwold High School
Lindenwold, Nj06.2016
Skills
- Billing management
- Benefits coordination
- Claims investigation
- Insurance terminology
- Document control
- Microsoft office
- Data entry
- Customer service
- Conflict resolution
Timeline
Claim Resolution Specialist
CalOptima Health
10.2017 - Current
HS Diploma -
Lindenwold High School
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