Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Karen (KC) Lewis

Millington ,TN

Summary

Experienced Claims Supervisor, with managing claims processes and leading teams to ensure efficient and accurate handling. Utilizes strong analytical skills and attention to detail to identify issues and implement effective solutions. Track record of fostering teamwork and maintaining high standards in claims management.

Overview

40
40
years of professional experience

Work History

Claims Supervisor

HealthSmart Benefit Solutions Acquired by UMR
03.1994 - Current
  • Assisted in the recruitment and selection of new claims adjusters, ensuring they possessed the necessary skills and expertise to excel in their roles.
  • Monitored performance metrics regularly, identifying areas for improvement and implementing corrective measures accordingly.
  • Fostered a positive work environment that promoted collaboration, teamwork, and open communication among staff members.
  • Managed a diverse caseload, prioritizing tasks effectively to meet strict deadlines and maintain quality standards.
  • Contributed to the development and implementation of departmental goals and objectives, aligning them with broader organizational strategies.
  • Optimized resources allocation by monitoring workload distribution among team members, leading to increased efficiency within the department.
  • Enhanced team productivity by providing ongoing training and mentorship to claims adjusters.
  • Coordinated resources efficiently during high-volume periods, ensuring seamless operations without compromising service levels.
  • Documented and communicated timely claims information while supporting accurate outcomes.
  • Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times.
  • Reduced claim processing time by implementing efficient workflow improvements and streamlining processes.

Medical Claims Processor

Insurex Benefits Administrators
04.1992 - 03.1994
  • Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Responded to correspondence from insurance companies.

Medical Claims Processor

Pittman & Accosiates, Inc
09.1990 - 04.1992
  • Paid or denied medical claims based upon established claims processing criteria.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Responded to correspondence from insurance companies.

Claims Supervisor

Blue Cross Blue Shield of Memphis
01.1985 - 09.1990
  • Maintained up-to-date knowledge on industry trends, best practices, and regulatory changes to ensure optimal decision-making in the claims management process.
  • Increased accuracy in claim evaluations through comprehensive documentation and attention to detail.
  • Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
  • Managed a high volume of claims daily, prioritizing workload according to urgency and complexity.
  • Improved claim processing efficiency by streamlining workflows and implementing new software tools.
  • Optimized resource allocation by monitoring staff productivity levels and adjusting assignments accordingly.

Education

High School Diploma -

Frayser High School
Memphis, TN
05-1982

Skills

  • Claims team management through change expertise
  • Teamwork motivation and collaboration
  • Performance monitoring
  • Active listening
  • Proficient in Microsoft Word, Microsoft Excel, Adobe Acrobat, QicLink Claims Processing System, and Sharepoint
  • Adaptability and flexibility
  • Procedure implementation
  • Attention to detail
  • Excellent communication
  • Problem-solving abilities
  • Time management abilities
  • Analytical thinking

Accomplishments

    Coordinated and built the workflow, routing rules and processes within the Imaging Workflow System (IWS) for 5 different teams within HealthSmart. IWS is used to store, document and process all incoming correspondence related to a claim, such as, accident and subrogation information, other insurance information, appeals, pre-determinations, etc.

    Coordinated and built the workflow, routing rules and processes within the Large Claim IWS (LCPP IWS) for 13 different categories based on teams within HealthSmart. LCPP IWS was used for claims over 100K to ensure accuracy, completeness from processing, to auditing and release of payment. Any and all attachments related to 100K claims are stored in this system.

    In collaboration with my director and manager and all teams involved, researched, built and implemented the rules for Optum Overpayment recovery for all HealthSmart Teams.

Timeline

Claims Supervisor

HealthSmart Benefit Solutions Acquired by UMR
03.1994 - Current

Medical Claims Processor

Insurex Benefits Administrators
04.1992 - 03.1994

Medical Claims Processor

Pittman & Accosiates, Inc
09.1990 - 04.1992

Claims Supervisor

Blue Cross Blue Shield of Memphis
01.1985 - 09.1990

High School Diploma -

Frayser High School

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Karen (KC) Lewis