LAUREN KRESS
Omaha
Summary
Dynamic insurance professional with extensive experience at Detego Health LLC, excelling in claims processing and customer service. Proven ability to enhance operational efficiency and resolve complex issues. Skilled in regulatory compliance and documentation management, fostering strong client relationships while ensuring accurate claims handling. Committed to delivering exceptional service and support in the insurance industry.
Overview
5
5
years of professional experience
Work History
Insurance Specialist
Detego Health LLc
Omaha
12.2024 - 09.2025
- Reviewed insurance claims for accuracy and compliance with company policies.
- Collaborated with healthcare providers to gather necessary documentation for claims processing.
- Provided guidance to clients regarding insurance coverage options and benefits.
- Assisted in resolving client inquiries related to insurance policies and claims status.
- Maintained detailed records of client interactions and claims submissions in database systems.
- Educated clients on policy details, coverage limits, and exclusions effectively.
- Coordinated with internal teams to streamline claims processing workflows and improve efficiency.
- Reviewed insurance policies to ensure compliance with existing regulations.
- Provided guidance to customers regarding available insurance plans and their benefits and limitations.
- Ensured that customer data was kept confidential at all times in accordance with applicable laws and regulations.
Claims Specialist
Physicians Laboratory
Omaha
08.2023 - 07.2024
- Reviewed and processed claims for accuracy and compliance with regulations.
- Communicated with healthcare providers to gather necessary documentation.
- Investigated claim discrepancies by analyzing relevant information and records.
- Coordinated with insurance companies to facilitate timely claim resolutions.
- Maintained detailed records of claims status in the management system.
- Assisted colleagues in training on claims processing procedures and guidelines.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Processed payments for valid claims according to established procedures.
Claims Auditor
Pacific Life
10.2022 - 12.2022
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements
- Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues
- Prioritized daily tasks to manage workload demands and department's turnaround goals.
Julios
06.2022 - 12.2022
- Worked with POS system to place orders, manage tickets, and handle complimentary items
- Served food and beverages with focused attention to customer needs
- Trained new staff on operational structure and POS system
- Maintained clean and organized dining areas to uphold restaurant standards.
Claims Processor
Principle Choice
09.2020 - 03.2021
- Utilized specialized VA software to process incoming claims, enter data and generate reports
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes
- Managed workload and priorities to meet claims processing meet deadlines
- Worked on several initiatives to keep productivity up and facilitate faster processes to keep queue's clear.
Education
Associate of Applied Science - Pre-Nursing
South College
Knoxville07-2026
Associate of Applied Science - Psychology
Metropolitan Community College
Omaha, NESkills
- Disability Processing
- Training Programs
- Regulatory Requirements
- Claims processing
- Customer service
- Data analysis
- Documentation management
- Effective communication
- Problem resolution
- Claims management
- Documentation
- Account management
- Vision and dental insurance
- Health insurance
- Service oriented
- Insurance eligibility
- Multitasking
Timeline
Insurance Specialist
Detego Health LLc
12.2024 - 09.2025
Claims Specialist
Physicians Laboratory
08.2023 - 07.2024
Claims Auditor
Pacific Life
10.2022 - 12.2022
Julios
06.2022 - 12.2022
Claims Processor
Principle Choice
09.2020 - 03.2021
Associate of Applied Science - Pre-Nursing
South College
Associate of Applied Science - Psychology
Metropolitan Community College