LARHONDA DELBRIDGE
Rocky Mount,NC
Summary
Proven Claims Analyst with a track record of enhancing customer satisfaction and reducing claim submission errors at Spectraforce Technologies Inc. Excels in claims analysis and interpersonal communication, achieving timely claim resolutions through meticulous attention to detail and effective problem-solving. Demonstrates exceptional proficiency in data interpretation and healthcare coding, alongside a commitment to teamwork and reliability.
Overview
3
3
years of professional experience
Work History
Claims Analyst
Lumen Solutions
12.2023 - 05.2024
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
- Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
Medical Claims Specialist
Spectraforce Technologies Inc.
12.2020 - 12.2023
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Improved claim processing efficiency by streamlining workflows and implementing best practices.
- Effectively resolved claim disputes by conducting thorough investigations and presenting findings to stakeholders clearly and concisely.
- Managed high volume of claims, consistently meeting deadlines without compromising accuracy or quality.
- Maintained accurate patient records by diligently updating databases and following strict documentation guidelines.
- Submitted electronic/paper claims documentation for timely filing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Paid or denied medical claims based upon established claims processing criteria.
- Managed large volume of medical claims on daily basis.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
- Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.
- Achieved timely reimbursements for clients through keen understanding of insurance company protocols.
Education
Associate of Applied Science - Health
Community College of Aurora
Aurora, CO05-2007
High School Diploma -
William C Hinkley
Aurora, CO05-1987
Skills
- Claims
- Claims analysis
- Interpersonal and written communication
- Policy interpretation
- Data interpretation
- Proficient in [software]
- Claim investigation
- Claims review
- Claims trend analysis
- Claims history analysis
- Claims processing
- Critical thinking
- MS office
- Decision-making
- Active listening
- Healthcare common procedures coding system (HCPCS)
- File and record management
- Claims adjustment
- Teamwork and collaboration
- Attention to detail
- Time management
- Problem-solving abilities
- Multitasking Abilities
- Reliability
Timeline
Claims Analyst
Lumen Solutions
12.2023 - 05.2024
Medical Claims Specialist
Spectraforce Technologies Inc.
12.2020 - 12.2023
Associate of Applied Science - Health
Community College of Aurora
High School Diploma -
William C Hinkley
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