Kenneth McGlauchlen
Weston
Summary
Dynamic Claims Research & Resolution Manager at Inclusa, Inc. with proven expertise in project planning and regulatory compliance. Skilled in training teams and analyzing data to uncover fraudulent practices, ensuring provider contract adherence. Recognized for enhancing workflow efficiency and delivering impactful financial reports, driving organizational success through effective communication and leadership.
Overview
7
7
years of professional experience
Work History
Claims Research & Resolution Manager
Inclusa, Inc.
04.2024 - Current
- Managed workflow timelines to ensure all quarterly objectives are completed on time.
- Delegated workload to ensure efficient completion of work.
- Trained new associates in department functions and individual work processes.
- Created/maintained up to date process documentation for all department tasks and responsibilities.
- Partnered with Authorizations and Provider Relations teams to carry out special projects and investigations.
- Managed all incoming/outgoing communication from the audit specific email inbox.
Claims Research & Resolution Professional
Inclusa, Inc.
02.2022 - 04.2024
- Audited medicare claims to ensure no fraud is taking place.
- Compiled and prepare financial reports for healthcare providers.
- Ensured provider contract compliance.
- Researched suspicious activities to uncover fraudulent practices.
- Read trends in billing and services provided for compliance.
Accounting Specialist
Sutton Transport
06.2021 - 02.2022
- Managed customer receivable balances and secured funds from delinquent accounts.
- Processed cash applications of customer payments in an internal accounting system.
- Audited customer claims and processed invoice adjustments accordingly.
Auditor Specialist
GlobalTranz
09.2018 - 06.2021
- Audited freight invoices to ensure correct application of pricing.
- Processed shipping documents in an internal system.
- Interfaced with colleagues to solve complex problems.
Education
BBA - Advanced Business Communication
University of Wisconsin, Eau Claire
Eau Claire, WI06-2018
Skills
- Project planning
- Computer skills
- Employee training
- Analytical skills
- Presenting
- Writing
- Team leadership
- Business analysis and reporting
- Regulatory compliance
- Effective communication
- Data analysis
- Finance
Timeline
Claims Research & Resolution Manager
Inclusa, Inc.
04.2024 - Current
Claims Research & Resolution Professional
Inclusa, Inc.
02.2022 - 04.2024
Accounting Specialist
Sutton Transport
06.2021 - 02.2022
Auditor Specialist
GlobalTranz
09.2018 - 06.2021
BBA - Advanced Business Communication
University of Wisconsin, Eau Claire
Performance History
- UWEC Blugold Marching Band: Snare Drum 2013 - 2017
- UWEC Symphony Band: Percussion 2013 - 2015
- UWEC Wind Symphony: Percussion 2015 - 2016
- UWEC Symphony Orchestra: Principal Percussion 2016
- MN Brass Indoor Drum Line: Front Ensemble 2013 - 2016
- Oregon Crusaders Drum & Bugle Corps: Front Ensemble 2015 - 2016
- Green Bay Packers Tundra Line: Snare Drum 2021 - Present
- Highland Community Church Worship Team: Drums 2024 - Present
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