Lesley Pierson
Omaha,NE
Summary
Results-driven Medicare Claims Specialist at Mutual Of Omaha Insurance Company, skilled in claims investigation and team collaboration. Achieved consistent performance targets through effective multitasking and a strong focus on customer satisfaction. Enhanced claim processing efficiency, reducing turnaround times while maintaining accuracy and reliability in high-pressure environments.
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
24
24
years of professional experience
Work History
Medicare Claims Specialist
Mutual Of Omaha Insurance Company
03.2001 - Current
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Followed up with customers on unresolved issues.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Enhanced accuracy of claim assessments by adopting advanced analytical tools, leading to more informed decision-making.
- Enhanced data integrity and security in claim management systems, protecting sensitive information from potential breaches.
- Negotiated settlements with claimants and attorneys, achieving favorable outcomes for all parties involved.
- Enhanced customer trust and satisfaction by efficiently resolving claims disputes.
- Provided expert advice on complex claim issues, aiding in resolution of high-stakes disputes.
- Conducted regular audits of claim files, ensuring compliance with internal and external regulations and standards.
- Implemented customer feedback mechanisms to identify areas for improvement in claims process, leading to strategic enhancements.
- Analyzed claim documents to ensure accuracy and compliance, mitigating risk of financial loss.
- Conducted detailed investigations into suspicious claims, successfully identifying and addressing fraudulent activities.
- Coordinated with legal teams on complex claims, ensuring all regulatory requirements were met and protecting company interests.
- Reduced fraudulent claims by implementing stringent verification processes, safeguarding company assets.
- Streamlined claims processing procedures, significantly reducing turnaround times and improving client satisfaction.
- Evaluated and settled complex insurance claims in strict timeframes.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
Education
Associate of Arts - Early Childhood Education And Care
Iowa Western Community College
Council Bluffs, IA05-1985
Skills
- Claims investigation
- Claims trend analysis
- Multitasking
- Reliability
- Team collaboration
Timeline
Medicare Claims Specialist
Mutual Of Omaha Insurance Company
03.2001 - Current
Associate of Arts - Early Childhood Education And Care
Iowa Western Community College
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