Kaitlin Hall
Alden,NY
Summary
Dynamic Claims Analyst with a proven track record within the Federal Government, specializing in claims investigation and financial analysis. Recognized for achieving 99% quality compliance, utilizes strong problem-solving skills and effective communication to streamline workflows and foster team collaboration, ensuring timely and accurate claims processing for clients. Results-driven professional with extensive experience in financial analysis and claims management. Skilled in effective communication and decision-making, contributing to timely benefit delivery and compliance adherence for Veterans' claims.
Overview
7
7
years of professional experience
Work History
Veteran Claim Examiner
Department Of Veterans Affairs - United States Government
Buffalo, NY
02.2021 - Current
- Mentored Claim Examiners through coaching, training sessions, and performance evaluations.
- Conducted thorough investigations into complex claims, gathering evidence and interviewing parties involved.
- Established strong relationships with independent adjusters for efficient assessments of large-scale Federal claims.
- Interviewed veterans, claimants, and representatives to accurately develop claims.
- Processed claims within designated authority to ensure timely delivery of benefits to Veterans.
- Ensured compliance with federal regulations by auditing claim files and documentation regularly.
- Reviewed claims for accuracy and adherence to federal guidelines.
- Analyzed documentation to determine eligibility for veteran benefits.
Claims Analyst
Centene
05.2020 - 02.2021
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Analyze and provide comprehensive risk assessment and transaction review to prevent fraud.
- Recovered and retrieved funds from providers due to overpayments and adjusted claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
Claim EXAMINER
Health First Health Plans
05.2019 - 04.2020
- Promoted from customer care representative to Claim Examiner.
- Assessed the financial review and fraud identification to find flaws, optimize workflow and prevent fraud.
- Reviews appeals and complaints; researches any missing or required information.
- Respond to providers, members, or other company departments to process and resolve the claim issue.
- Achieved 99% quality compliance and on-time reporting that led to being awarded increased responsibility to High Dollar claim review, Provider Dispute and Corrected Claims.
Education
Certified Professional Coder -
AAPC
Online04.2021
Associate of Applied Science - Applied Social Science, Psychology Concentration
Niagara County Community College
Sanborn, NY05.2009
High School Diploma -
Niagara Wheatfield High School
Sanborn, NY06.2007
Skills
- Claims investigation and policy interpretation
- Financial analysis
- Team collaboration
- Analytical problem-solving
- Attention to detail
- Effective communication
- Decision-making and computer skills
Timeline
Veteran Claim Examiner
Department Of Veterans Affairs - United States Government
02.2021 - Current
Claims Analyst
Centene
05.2020 - 02.2021
Claim EXAMINER
Health First Health Plans
05.2019 - 04.2020
Certified Professional Coder -
AAPC
Associate of Applied Science - Applied Social Science, Psychology Concentration
Niagara County Community College
High School Diploma -
Niagara Wheatfield High School