Summary
Overview
Work History
Education
Skills
Certification
Affiliations
Accomplishments
CESI culture advocate
Timeline
Generic

Karen M. Settle

Mertztown,Pennsylvania

Summary

Accomplished Medical Claims Analyst with a proven track record at CVS Health, enhancing claim processing efficiency and customer satisfaction. Expert in medical terminology and HIPAA compliance, with a flair for mentoring and team collaboration. I also do departmental reports, demonstrating exceptional organizational and communication skills and a keen ability to multitask and collaborate effectively within teams.

Overview

34
34
years of professional experience
1
1
Certification

Work History

Medical Claims Analyst

CVS Health
03.2003 - Current
  • Ensured accurate payments by meticulously reviewing medical records, invoices, and supporting documentation.
  • Maintained regulatory compliance by staying current with industry guidelines, state laws, and federal regulations.
  • Support management''s decision-making process by providing insightful reports analyzing historical claims data.
  • Demonstrate a commitment to continuous improvement by actively seeking out opportunities for better processes within the Medical Claims Analyst role.
  • Improved customer satisfaction by resolving complex medical claims in a timely and professional manner.
  • Provided exceptional customer service, addressing inquiries regarding coverage, benefits, and claim statuses promptly and professionally.
  • Mentored junior analysts within the team to promote professional growth opportunities amongst peers.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Managed large volume of medical claims on daily basis.
  • Enhanced claim processing efficiency by implementing automated workflows and streamlining procedures.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.

Customer Service Representative

Aetna Insurance
03.1993 - 03.2003
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
  • Responded to customer requests for products, services, and company information.
  • Acted as liaison between Aetna and UFT to handle high level complaints and payments.

Claims Processor

Aetna Insurance
03.1990 - 02.1993
  • Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
  • Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.
  • Managed workload and priorities to meet claims processing meet deadlines.

Education

High School Diploma -

Salem Christian School
Macungie PA

Studied Occupational Therapy

Lehigh Carbon Community College
Schnecksville, PA

Skills

  • Medical Terminology Familiarity
  • Training and mentoring
  • Multitasking strengths
  • Time management
  • HIPAA Compliance Understanding
  • Customer Service
  • Medical record review
  • Excellent Communication
  • Organizational Skills
  • Team Collaboration
  • Reporting skills
  • Excellent administrative abilities

Certification

First Aid/CPR Certified

Affiliations

  • I am an active volunteer within my community. I volunteer and our local food bank and dog sanctuary. I am very involved in church and our band where I sing and play piano.

Accomplishments

As a culture advocate I am the face of Culture, Diversity & Inclusion within the organization. I provide input on initiatives and priorities for change and bring ideas forward. I also model the Heart at work behaviors and Helping with Heart actions.

CESI culture advocate

As a culture advocate I am the face of Culture, Diversity & Inclusion within the organization.  I provide input on initiatives and priorities for change and bring ideas forward.  I also model the Heart at work behaviors and Helping with Heart actions.

Timeline

Medical Claims Analyst

CVS Health
03.2003 - Current

Customer Service Representative

Aetna Insurance
03.1993 - 03.2003

Claims Processor

Aetna Insurance
03.1990 - 02.1993

High School Diploma -

Salem Christian School

Studied Occupational Therapy

Lehigh Carbon Community College

Similar Profiles

CREATE PROFILE
Karen M. Settle