Kathleen Virgin
Cheswick,PA
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
3
3
years of professional experience
Work History
Sr. Claims Benefit Specialist
Aetna
- Review and adjudicate complex, sensitive, and/or specialized encounters in accordance with State driven encounter processing guidelines.
- Act as subject matter expert providing training, coaching or responding to complex issues.
- In-depth understanding guidelines and rules for multiple Medicare, Medicaid, HMO, HSA, HRA and PPO plans.
- Responsible for a wide variety of claims from physician's claims to hospital facility claims.
- Ability to provide coordination of benefits between multiple plans
- Work with Quality Department to analyze error reports and identify solutions.
- Oversee error tracking of new claims processing group, notify group of trends in processing errors and send correct policies.
- Call center experience.
Office Manager
Virgin Flooring
07.2021 - Current
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Maintained computer and physical filing systems.
- Created, maintained and updated filing systems for paper and electronic documents.
- Developed and maintained successful relationships with vendors, suppliers and contractors.
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
- Enhanced team productivity by delegating tasks effectively and overseeing daily workflow.
- Assisted in the recruitment process, conducting interviews and onboarding new employees to promote a seamless integration into the team dynamic.
- Coached new hires on company processes while managing employees to achieve maximum production.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records.
Education
High School Diploma -
Seneca Valley High School
Harmony, PA06.1996
Skills
- Claims Management Expertise
- Attention to detail and accuracy
- Superior organizational skills
- Exceptional interpersonal skills
- Conflict Resolution Strategies
- Continuous Process Improvement
- Medical Terminology Mastery
- Extensive Insurance Industry Experience
- Teamwork and Collaboration
- Customer Service
- Attention to Detail
- Organizing and Prioritizing Work
- Critical Thinking
- Active Listening
- Worked from home for over 6 years can work independently and meet deadlines
- Decision-Making
- Documentation skills
- Data Entry
- Medical Terminology
Timeline
Office Manager
Virgin Flooring
07.2021 - Current
Sr. Claims Benefit Specialist
Aetna
High School Diploma -
Seneca Valley High School
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