Summary
Overview
Work History
Education
Skills
Timeline
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Kristen Felger

Las Vegas

Summary

Hardworking and passionate Medical Claims Supervisor with strong background in managing in fast pace environments. Dedicated to utilizing open and honest communication in order to build successful processes and implement changes seamlessly in an ever-changing and growing environment. Passionate about consistently learning, being challenged, understanding the why and continuously using problem solving skills to reach the best outcome. Thrives under pressure and enjoys being inquisitive and curious about how operations work to always be evolving.

Overview

12
12
years of professional experience

Work History

Medical Claims Supervisor

Gravie
08.2023 - Current
  • Established strong relationships with other departments to improve overall processing of claims, including RRT, Gravie Care, Configuration, Auditing, and outside partners.
  • Contributed to the creation of a positive work environment through open communication and proactive problem-solving initiatives.
  • Worked with Data Analytics to develop comprehensive reports on departmental performance metrics, informing executive-level decision making.
  • Managed inventory for a high volume of claims daily, prioritizing workload according to urgency and complexity.
  • Optimized resource allocation by monitoring staff productivity levels and adjusting assignments accordingly to meet turn-around-time.
  • Reduced claim errors by creating process workflows, establishing forms to provide prompt feedback and reviewing auditing errors with medical examiners.
  • Oversaw regular audits of processed claims to identify patterns and establish gaps within workflows.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Coordinated with Issue Resolution Specialists, Compliance and Senior Managers to enhance Out of Network Form to improve success of claim payment between members and clearing house.
  • Participated in strategic planning sessions aimed at enhancing overall claim operations.
  • Created, established, and reviewed KPI reporting to understand claim processing inefficiencies to improve the overall productivity of the department.

Supervisor - Customer Service

Zappos.com
10.2018 - 08.2023
  • Managed teams of 20+ customer service agents to provide customers with Zappos' number one Core Value - Deliver WOW Through Service.
  • Evaluated employee performance through KPI’s, Quality, the voice of the customer, etc. in order to properly coach and train direct reports to improve overall customer service experience.
  • Enforced processes and procedures to meet and exceed company expectations comprehensibly and consistently.
  • Handled internal customer complaints, resolved issues, and met with necessary departments (HR, Benefits, Scheduling, Quality, etc.) in order to implement adjustments in policies to meet changing needs.
  • Developed and documented effective improvement plans in alignment with goals and specifications.
  • Cultivated positive, trusting relationships built on honestly and transparency to achieve goals and implement necessary changes.
  • Experienced in handling customer escalations, understanding the back-end data and implementing changes to provide an overall better customer experience
  • Managed QA teams, researched negative and positive response rates from customers and implemented effective coaching to create better experiences internally and externally.

Customer Service Representative

Zappos.com
10.2012 - 10.2018
  • Assisted and managed over 30+ customers through multiple channels (Phone, Live Chat, and email) daily to provide exceptional customer service.
  • Worked diligently in Zappos' Order Verification Department to protect customers against fraudulent activity.
  • Worked in Zappos' Resource Department assisting team members with work flows, escalations and following up on unresolved issues/complaints.
  • Exercised leadership capabilities by successfully motivating and inspiring others.
  • Used critical thinking to break down problems, evaluate solutions and make decisions.
  • Skilled at working independently and collaboratively in team environment.

Education

High School Diploma -

Nevada State High School
Henderson, NV

Skills

  • Strong decision-making
  • Professionalism and Integrity
  • Staff Training and Development
  • Continuous Learning Commitment
  • Organizational capabilities
  • Process improvement strategies
  • Conflict resolution techniques
  • Results-driven approach
  • Deadline Oriented Mindset
  • Workflow Optimization Techniques
  • Collaborative Teamwork Attitude
  • Attention to Detail
  • Effective Communication

Timeline

Medical Claims Supervisor

Gravie
08.2023 - Current

Supervisor - Customer Service

Zappos.com
10.2018 - 08.2023

Customer Service Representative

Zappos.com
10.2012 - 10.2018

High School Diploma -

Nevada State High School

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Kristen Felger