Kimberly Thomas
Crowley,TX
Summary
Senior Claims Business Processing Analyst with deep knowledge of health claims industry. Solid abilities in developing objectives and strategies to settle provider/customer claims and technical problem resolution. Excellent skills compiling, coding, categorizing and auditing information to aid in the process of claim resolution and quality. Successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering years of experience and willingness to take on any challenge.
Overview
30
30
years of professional experience
Work History
Claims Analyst
A&I Ops-UHOne & US Health Group
02.2017 - 02.2018
- Reduced claims processing time by implementing efficient analytical techniques and strategies.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Over 10 years experience
Senior Claims Business Processing Analyst
A&I Ops-UHOne & US Health Group
02.2018 - Current
- Responsible for providing research and root cause analysis for claims processing quality
- Identify root cause failures and develop action plans for escalated issues
- Responsible for all acts of quality assurance
- Engage in predictive analytics to prevent system and other claim related issues from impacting provider
- Follow standard programming guidelines and requirements
- Standard documentation and tracking processes
- Liaison between Claims Department and the IT
- Act as point of contact for issues on claims processing while collaborating with IT on problem resolution and follow up with remediating action plans
- Oversee testing of new products and/or changes to existing products
- Track and monitor multiple ongoing projects for status and resolution
- Uses pertinent data and facts to identify and solve a range of problems within area of expertise.
- Over 10 years experience
Education
Business Administration -
Hodges University
Fort Myers, FL01.2018
Skills
- Proficient in but not limited to: technical and claims processing based environment to include analyzing and customer service Microsoft Excel (creating spreadsheets), Microsoft Word (creating documents), Microsoft Outlook (drafting emails, calendar management) System knowledge: AS400, Tableau, LegaSuite, OZ, Sharepoint
- Claims Analysis
- Interpersonal and Written Communication
- Dispute Tracking
- Policy Interpretation
- Decision Making
- Critical Thinking
- Problem Solving
- Conflict Resolution
- Policy Investigations
- Decision-Making
- Claims Evaluation
- Analytical Thinking
Timeline
Senior Claims Business Processing Analyst
A&I Ops-UHOne & US Health Group
02.2018 - Current
Claims Analyst
A&I Ops-UHOne & US Health Group
02.2017 - 02.2018
Business Administration -
Hodges University
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