Laura Wallace
Summary
Diligent claims processing subject matter expert with thorough understanding of claim processing procedures and efficient handling of complex claims. Demonstrated ability to ensure accuracy and compliance, enhancing operational efficiency. Proven track record of utilizing attention to detail and analytical skills to resolve issues and support team success.
Overview
18
18
years of professional experience
Work History
Claims Processor
Horizon Blue Cross Blue Shield of NJ
03.2008 - Current
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Managed workload and priorities to meet claims processing meet deadlines.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Trained new employees on claims processing procedures, contributing to a well-prepared workforce.
- Evaluated accuracy and quality of data entered into agency management system.
- Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Has obtained multiple restricted access to edits including M843, M405, E905, E907, E917, K324, M676, E915.
- Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Provided support during internal and external audits, ensuring accurate representation of the company''s claim history.
- Enhanced claim processing efficiency by streamlining procedures and creating workflows for difficult edits.
- Collaborated with multiple department in the company and has vast network capabilities.
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
- Assisted in updating company guidelines for consistent application of policies across all claims processed.
- Streamlined communication channels between departments for more efficient handling of claim-related inquiries from both customers and colleagues alike.
- Implemented cost-saving measures by identifying unnecessary expenses in the claims process.
- Improved accuracy in claims evaluation, applying detailed knowledge of policy terms and conditions.
- Reduced backlog of pending claims, prioritizing tasks effectively and efficiently.
- Supported team members in achieving their personal and professional goals, fostering collaborative and supportive work environment.
- Expedited settlement of complex claims, collaborating closely with adjusters and other stakeholders.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Modified, updated and processed existing policies.
- Evaluated and settled complex insurance claims in strict timeframes.
- Demonstrated exceptional problem-solving skills while handling challenging cases, leading to satisfactory outcomes for both the company and client.
- Proficient in multiple company based applications including NASCO, Burgess, TPX, BlueCard, CPL, FileNet, several Share Point.
- Processes No Fault, Coordination of Benefits, Medicare, ESRD claims.
- Assisted with multiple company projects throughout 18 year career which included OON Arbitration Project,
- Mentored junior team members, contributing to their professional growth and development.
- Enhanced team performance by providing expert guidance on critical projects and strategic initiatives.
- Optimized subject matter content by conducting extensive research and incorporating industry trends.
Education
Associate of Science - Biology And Chemistry
Burlington County College
Burlington County NJ05-1992
Skills
- Claims review
- Accuracy and precision
- Transactions reconciliation
- Claims
- Expert knowledge of claims processing software
- Regulatory compliance
- Medical terminology
- Technical aptitude
- Critical evaluation
- Claims trend analysis
- Attention to detail
- Claims processing
- Claims adjustment
- Critical thinking
- Claim amount calculations
- Microsoft office
- Organizing and prioritizing work
- Collaborative relationships
- Documentation skills
- Information verification
- Denied claims identification
- Number-savvy
- Independent Decision-making
- Teamwork and collaboration
- High Dollar Claim Payout
- Extensive Knowledge in Facility processing
- Problem-solving abilities
- Multitasking Abilities
Timeline
Claims Processor
Horizon Blue Cross Blue Shield of NJ
03.2008 - Current
Associate of Science - Biology And Chemistry
Burlington County College
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