Laura Holm
Indianapolis,IN
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Overview
36
36
years of professional experience
Work History
Medical Claims Analyst
Seven Corners
11.2007 - 04.2016
- Verified patient insurance coverage and benefits for medical claims.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Identified and resolved discrepancies between patient information and claims data.
- Followed up on denied claims to verify timely patient payment and resolution.
- Responded to correspondence from insurance companies.
- Generated reports on medical claims processing activities and results.
- Checked documentation for accuracy and validity on updated systems.
- Verified client information by analyzing existing evidence on file.
- Verified patient insurance coverage and benefits for medical claims
- Researched and resolved complex medical claims issues to support timely processing
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations
Call Center Customer Service Representative
IMG
03.2004 - 05.2005
- Helped customers every day with positive attitude and focus on customer satisfaction.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Documented and detailed calls and complaints using call center's CRM database.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Responded to customer calls and emails to answer questions about products and services.
- Addressed customer account discrepancies and concerns.
Personal Lines Customer Service Agent
Gregory & Appel
11.1996 - 04.1999
- Educated clients on insurance policies and procedures.
- Analyzed customer needs to provide customized insurance solutions.
- Met with customers to provide information about available products and policies.
- Determined financial needs by assessing existing coverage and aligning new products and services with long-term goals.
- Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas.
- Conducted annual reviews of existing policies to update information.
- Monitored customer feedback and identified areas of improvement.
- Evaluated competitors' products and services to gain competitive advantage.
- Researched and identified potential new markets.
- Designed presentations and marketing materials to promote insurance products.
Client Service Representative
Gardner & White
03.1990 - 11.1996
- Helped customers every day with positive attitude and focus on customer satisfaction.
- Responded to customer calls and emails to answer questions about products and services.
- Utilized active listening skills to identify customer needs and provide appropriate solutions.
- Maintained and managed customer files and databases.
- Coordinated with operations staff to resolve service problems and boost client satisfaction.
- Communicated with clients regarding account services, statements, and balances.
- Offered troubleshooting advice to assist customers with technical issues and navigate smooth process.
- Trained and supervised junior customer service representatives on best practices to meet organization goals.
- Developed and implemented customer satisfaction surveys to measure customer service quality.
- Delivered prompt service to prioritize customer needs.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Maintained up-to-date knowledge of product and service changes.
Quality Control Auditor
Blue Cross & Blue Shield Of IN
01.1980 - 05.1986
- Identified issues of non-compliance and elevated reports to senior personnel.
- Monitored departmental forms for compliance to submissions rules and guidelines.
- Participated in compliance inquiries and provided interpretation of data to guide investigators in creation of Corrective and Preventive Actions.
- Performed continuous random spot reviews of daily log pages, non-routine and work package contents for completeness, correct use of appropriate references and approved data.
- Completed timely quality reports highlighting deficiencies and recommending corrective actions.
- Educated and oriented employees to improve compliance with quality control protocols.
- Scheduled and executed quarterly yearly audits.
- Gathered and reviewed current data to determine areas in need of improvement.
- Developed and implemented system to provide continuous evaluation of claims processing performance.
- Determined correct procedures for inspection and review to standardized audit processes.
Education
Bachelor of Arts - Psychology
Indiana University Bloomington
Indianapolis, INSkills
- Process Improvement
- Policy Improvements
- Complex Problem-Solving
- Contract Analysis
- Team Leadership
- Analytical Thinking
- Corrective Action Planning
- MS Excel
- Verbal and Written Communication
- Compliance Analysis
- Reading Comprehension
- Claim Validity Determination
- HIPAA Procedures
- Critical Thinking
- Telephone Etiquette
- Active Listening
- Medical Terminology
- ICD-9-CM Coding
- Social Perceptiveness
- Microsoft Office
- Insurance Terminology
- Knowledgeable about Diseases
- Insurance Calculation
- Reviewing Patient Information
- Outstanding Clerical Abilities
- Insurance Plan Verification
- Insurance Coverage Limits
- Medical Records and Documentation
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Medical Claims Analyst
Seven Corners
11.2007 - 04.2016
Call Center Customer Service Representative
IMG
03.2004 - 05.2005
Personal Lines Customer Service Agent
Gregory & Appel
11.1996 - 04.1999
Client Service Representative
Gardner & White
03.1990 - 11.1996
Quality Control Auditor
Blue Cross & Blue Shield Of IN
01.1980 - 05.1986
Bachelor of Arts - Psychology
Indiana University Bloomington
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