Kimberly Kealey
Claims Processor
Davenport,IA
Summary
Accomplished Claims Representative Associate at UnitedHealthcare, adept in policy interpretation and time management. Excelled in a fast-paced environment, significantly enhancing claims processing efficiency. Demonstrated exceptional decision-making and data analysis skills, fostering customer loyalty and operational excellence at Aldi through superior service and team leadership.
Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards.
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 8 years of insurance experience.
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.
Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions.
Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level position. Ready to help team achieve company goals.
Overview
17
17
years of professional experience
Work History
Claims Representative Associate
UnitedHealthcare
01.2017 - Current
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Collaborated with internal departments and external vendors to resolve claims.
- Developed in-depth understanding of insurance policies and procedures.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Processed and recorded new policies and claims.
- Verified client information by analyzing existing evidence on file.
- Coordinated with contracting department to resolve payer issues.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Load balanced and worked other states when needed.
- Worked claims at risk.
- Worked special projects.
- Calculated adjustments, premiums and refunds.
- Checked documentation for accuracy and validity on updated systems.
Assistant Manager/ Cashier
Aldi
07.2008 - 07.2015
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Generated repeat business through exceptional customer service.
- Offered hands-on assistance to customers, assessing needs, and maintaining current knowledge of consumer preferences.
- Supervised day-to-day operations to meet performance, quality and service expectations.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Welcomed customers and helped determine their needs.
- responded promptly to customer needs.
- Worked flexible schedule and extra shifts to meet business needs.
- Stocked, tagged and displayed merchandise as required.
- Processed refunds and exchanges in accordance with company policy.
- Used POS system to enter orders, process payments and issue receipts.
- Encouraged customers to make additional purchases by highlighting current deals and keeping lane well-stocked.
Education
Associate of Applied Science - Travel Business Management
Kaplan University
Davenport, IA03-2005
Skills
- Claims investigation
- Policy interpretation
- Time management
- Data analysis
- Claims trend analysis
- Flexible schedule
- Decision-making
- Documentation research
Accomplishments
- Documented and resolved billing two different years on a claim which led to sending back to provider and have them resubmit billing one years at a time.
- reaching out to provider to update information on claims so they would not have to resubmit, saving time and money.
Timeline
Claims Representative Associate
UnitedHealthcare
01.2017 - Current
Assistant Manager/ Cashier
Aldi
07.2008 - 07.2015
Associate of Applied Science - Travel Business Management
Kaplan University
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