Juanita McDougal
Darlington,SC
Summary
Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards.
Overview
17
17
years of professional experience
Work History
Claims Representative
The Cigna Group
09.2023 - Current
- Analyzed and addressed escalated claims to resolve issues quickly.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Updated claims system to track claim status and provide relevant information to other department.
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
- Maintained accurate and up-to-date records of claim information for future reference.
- Developed and implemented strategies to improve claim processes.
Claims Processor
BCBS
12.2012 - 09.2023
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Managed workload and priorities to meet claims processing meet deadlines.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
- Monitored claims processing trends to identify potential areas of improvement.
Human Resource Instructor/Writer
United States Army Reserve
12.2006 - 06.2021
- Tracked student progress, frequently checking in with struggling students and identifying root causes of problems.
- Observed and adopted new techniques from skilled instructors and lecturers.
- Improved student performance by defining clear goals and communicating performance metrics.
- Evaluated and revised lesson plans and course content to achieve student-centered learning.
- Promoted classroom safety, collaboration and best practices.
- Applied various teaching aids to minimize learning gaps and instruct and motivate students.
- Tested and evaluated students on materials presented in workshops and classes.
- Increased student participation via engaging lectures and assignments.
- Tested students to assess progress and adapted learning plans in alignment with performance.
- Developed and clearly presented classroom rules, guidelines and objectives.
- Enhanced student comprehension and shortened learning process through new teaching methods.
Education
Bachelor of Science - Information Technology
Salem International University
Salem, WV12.2011
Skills
- Settlement Determinations
- Policy Knowledge
- Accident Review
- Documentation Research
- Financial Assistance
- Payments Posting
- Informational Releases
- Accounts Payable and Accounts Receivable
- Detailed Instruction
- Student Rapport-Building
- Informative Lectures
- Instructional Techniques
Timeline
Claims Representative
The Cigna Group
09.2023 - Current
Claims Processor
BCBS
12.2012 - 09.2023
Human Resource Instructor/Writer
United States Army Reserve
12.2006 - 06.2021
Bachelor of Science - Information Technology
Salem International University
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