Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
5
5
years of professional experience
Work History
Medical Claims Analysis
United Health Group, Optum
07.2019 - Current
Enhanced claim processing efficiency by implementing automated workflows and streamlining procedures.
Reduced fraudulent claims by conducting thorough investigations and collaborating with the fraud detection team.
Improved customer satisfaction by resolving complex medical claims in a timely and professional manner.
Ensured accurate payments by meticulously reviewing medical records, invoices, and supporting documentation.
Managed high-volume caseloads for optimal productivity while maintaining strict attention to detail.
Achieved successful resolutions on disputed claims through effective collaboration between internal departments such as legal counsel and clinical experts.
Managed large volume of medical claims on daily basis.
Researched and resolved complex medical claims issues to support timely processing.
Used administrative guidelines as resource or to answer questions when processing medical claims.
Spoke with Nurses within the company to identify charges that are adjusted
Handled not warranted claims, Corrected claims and Duplicates
Entered claims into the company system from the patients Universal Bill
Evaluated medical claims for accuracy and completeness and researched missing data.
Medical Sales Agent
Mesa Labs
10.2018 - 07.2019
Enhanced client satisfaction by promptly addressing inquiries and providing accurate information on products and services.
Expanded customer base through effective networking, cold calling, and relationship-building strategies.
Streamlined internal processes for improved efficiency and productivity within the agency.
Assisted clients in navigating the claims process, ensuring timely resolution of issues and optimal outcomes.
Delivered exceptional customer service by proactively addressing concerns and fostering a positive experience throughout all interactions.
De-escalated and resolved customer complaints with punctual, polite and professional service.
Manager Case Management, Care & Disease Management Ops External Channel at United Health Group/Optum HealthManager Case Management, Care & Disease Management Ops External Channel at United Health Group/Optum Health