Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic
Kristin Downey

Kristin Downey

San Diego,CA

Summary

Dynamic individual with hands-on experience in leadership and customer service with a talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing Organizational goals. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Organizational growth.

Overview

14
14
years of professional experience

Work History

Supervisor, Fitness Reimbursement

American Specialty Health
02.2023 - Current
  • Led team in optimizing workflow and enhancing operational efficiency.
  • Mentored staff to improve skillsets and elevate performance standards.
  • Spearheaded strategic initiatives to streamline processes and reduce costs.
  • Directed cross-functional teams to achieve organizational goals.
  • Implemented quality control measures ensuring accuracy and consistency.
  • Developed training programs that boosted employee productivity.
  • Facilitated communication between departments for seamless collaboration.
  • Analyzed operational data to drive decision-making and strategic planning.
  • Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
  • Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
  • Resolved conflicts among team members promptly, maintaining a harmonious working environment conducive to productivity.
  • Enhanced communication within the team by holding regular meetings and encouraging open dialogue among all members.
  • Collaborated with other departments to achieve organizational goals, fostering teamwork across various functions.
  • Conducted performance evaluations for staff members, identifying areas of improvement and guiding professional development plans.
  • Reduced employee turnover by fostering a positive work environment and providing ongoing feedback to staff members.
  • Streamlined inventory management processes, leading to more organized and efficient work assignment system.
  • Improved customer satisfaction with prompt and courteous resolution of inquiries and complaints.
  • Increased team productivity by implementing efficient workflows and setting clear expectations for staff members.
  • Demonstrated commitment to the organization''s core values, leading by example and fostering a culture of excellence.
  • Developed staff skills through targeted training programs, resulting in improved performance and career growth opportunities.
  • Led successful project completions under tight deadlines, coordinating effectively across multiple teams.

Senior Analyst, Fitness Reimbursement

American Specialty Health
01.2017 - 02.2023
  • Oversight of 40+ corporate partners monthly files. This requires extensive tracking, record keeping, processing, reviewing, executing of queries, and collaboration in order for files to paid on time.
  • Daily assignment of analyst work of both pends and adjustments. Pulling pends for quality review and assigning to QR analyst.
  • Creating and execution of data reports requested by leadership, which includes the building of queries in MS Access.
  • Research and resolution of complex escalated issues.
  • Project management and delegation of urgent issues for quick resolution.
  • Training and mentoring new analysts on complex tasks.
  • Research and resolution of complex customer service issues.
  • Assisting with questions and inquiries inside and outside the department.
  • Identified patterns and trends in large data sets and provided actionable insights.

Fitness Claims Outreach Analyst

American Specialty Health
07.2013 - 01.2017
  • Worked with directly with members on resolving escalated cases regarding claim denials. Provided member education and a quick route that resulted in a positive experience.
  • Enhanced customer satisfaction rates through detailed analysis of customer feedback data and subsequent improvements in service offerings.
  • Researching escalated issues and providing detailed explanations to account managers.
  • Documented and logged all member interactions appropriately.
  • Handled high priority employer groups as requested by client.
  • Created training materials and led classes on a complex product that we handled.

Fitness Claims Examiner

American Specialty Health
07.2011 - 07.2013
  • Processing claims from all products while maintaining the production and accuracy requirements of 32 claims per hour with a 99% accuracy rate.
  • Assisted with training of new hires.
  • Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.

Education

High School Diploma -

San Diego High School
San Diego, CA
06.1999

Skills

  • Extensive background in Healthcare including pharmacy, vocation nursing, billing and claims
  • Understanding of HIPAA regulations
  • Medicare and CMS
  • Medicare Advantage and Supplemental Plans
  • Effective customer support
  • Team leadership
  • Results driven
  • Coaching and guidance
  • Critical thinking for problem-solving
  • Workforce development
  • Project oversight
  • Strong interpersonal skills
  • Proficient in managing priorities
  • Proficient in resolving disputes
  • Data analysis expertise
  • Cross-functional teamwork
  • Effective problem resolution
  • Responsive to new challenges
  • Proactive self-starter
  • Client relationship management
  • Training and mentoring
  • Employee motivation
  • Decision-making
  • Processes and procedures
  • Process improvement
  • Project management
  • Public speaking
  • MS Office experience
  • SQL experience
  • Verbal and written communication
  • Payroll processing
  • Documentation and reporting
  • Staff education
  • Multitasking
  • Time management
  • Active listening
  • Interpersonal skills
  • Professionalism
  • Process analysis
  • Continuous improvement
  • Customer relationship management
  • Organizational development
  • Teamwork
  • Issue research
  • Professional demeanor
  • Interpersonal communication
  • Task prioritization
  • Adaptability
  • Reliability
  • Excellent communication
  • Employee development
  • Workflow management
  • Quality control
  • Task delegation
  • Policy and procedure development
  • Data analytics
  • Goal oriented
  • Staff management
  • Customer service
  • Attention to detail

Accomplishments

  • Received multiple company wide monthly awards for Customer Service, Quality, Innovation and Teamwork
  • Self taught company system programming for claims processing, SQL and MS Access.
  • Excellent in MS applications such as Excel, Word, PowerPoint and others.
  • Completed 14 week course on leadership practices.
  • Updated tracking sheets with formulas to reduce time spent on productivity for staff.
  • Developed many of departments processes and procedures.
  • Received positive feedback on numerous occasions for providing top-notch customer service.

Timeline

Supervisor, Fitness Reimbursement

American Specialty Health
02.2023 - Current

Senior Analyst, Fitness Reimbursement

American Specialty Health
01.2017 - 02.2023

Fitness Claims Outreach Analyst

American Specialty Health
07.2013 - 01.2017

Fitness Claims Examiner

American Specialty Health
07.2011 - 07.2013

High School Diploma -

San Diego High School

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