Angela Rohrer
Mapleton,IL
Overview
16
16
years of professional experience
Work History
Claims Manager
Insurance Program Managers Group
07.2022 - 08.2024
- Collaborated with cross functional teams to include customer service, client service, stop loss, and compliance to improve overall organizational efficiency and effectiveness.
- Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
- Managed a team of of professional level claim analysts responsible for the adjudication and payment of medical, dental and vision claims.
- Developed training materials to ensure consistent handling of claims across the department.
- Managed cost containment reviews and negotiations, ensuring timely follow-up with clients, providers and staff.
- Assisted with streamlining communications between account management and clients, expediting claim resolutions times.
- Served as senior liaison for client and broker contacts for claims delivery items.
- Oversaw audits of claim files ensuring financial and procedural accuracy and adherence to established industry regulations and guidelines.
Claims Specialist
Insurance Program Managers Group
01.2016 - 06.2022
- Enhanced customer satisfaction with timely communication and clear explanations of claim outcomes.
- Managed the investigation and resolution of complex claim files.
- Collaborated with clinical team to facilitate claims reviews for standard of care and medical necessity in accordance with plan guidelines.
- Served as lead for review and response to all filed appeals and grievances
- Coordinated with medical management in responding to submissions for pre-determinations of benefits.
- Provided feedback to management regarding industry trends and changes for the purpose of maintaining compliance.
- Analyzed and provided feedback on client specific plan documents to ensure accuracy and uniformity with claims workflows and procedures.
Health Claims Supervisor
Pekin Life Insurance Company
09.2012 - 01.2016
- Supervised a team of 10 claim analysts responsible for the administration of fully insured and self-insured health benefits.
- Handled complex claim adjustments and was responsible for the release of high dollar claims.
- Assisted with staffing of the claims division.
- Monitored the distribution, processing, and progress of daily work.
- Conducted monthly audits and provided performance metrics to management.
- Handled the investigation and resolution of DOI appeals and grievances.
- Oversaw claim cost containment initiatives.
- Filed monthly reinsurance reports.
Health Claims Specialist
Pekin Life Insurance Company
08.2008 - 09.2012
Education
Master of Science - Dietetics
Eastern Illinois University
Charleston, ILBachelor of Science - Dietetics
Eastern Illinois University
Charleston, ILSkills
- Excellent written and verbal communication
- Team building and leadership experience
- Strong policy interpretation skills
- Knowledge of employee benefits and insurance laws and regulations
- Complex Problem-solving
- Analytical thinking
Timeline
Claims Manager
Insurance Program Managers Group
07.2022 - 08.2024
Claims Specialist
Insurance Program Managers Group
01.2016 - 06.2022
Health Claims Supervisor
Pekin Life Insurance Company
09.2012 - 01.2016
Health Claims Specialist
Pekin Life Insurance Company
08.2008 - 09.2012
Master of Science - Dietetics
Eastern Illinois University
Bachelor of Science - Dietetics
Eastern Illinois University
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