Libby Schweitzer
Appleton,WI
Summary
Experienced Senior Claims Examiner specializing in claims evaluation and adherence to regulatory standards. Track record of increasing decision transparency and effectively resolving client disputes. Strong skills in team training and process streamlining, contributing to enhanced operational efficiency and customer satisfaction.
Overview
18
18
years of professional experience
Work History
Senior Claims Examiner/ Health Claims
Thrivent
Appleton, WI
01.2019 - Current
- Assess benefit eligibility by examining complex claims across various product lines.
- Ensure compliance with state and federal regulations through thorough investigations.
- Deliver detailed analyses for appeals from dissatisfied claimants, enhancing decision transparency.
- Address escalated client complaints related to denied or delayed payments efficiently.
- Maintain compliance with company standards by conducting periodic claims audits.
- Identify discrepancies in claims versus treatment history through medical record analysis.
- Train new employees on effective claims-handling procedures to improve operational efficiency.
- Act as a liaison between claim examiners, senior management, and other departments.
- Coordinate efforts among multiple departments to streamline claim processing functions.
- Business Continuity Management Representative
Claims Examiner/ Health Claims
Thrivent
Appleton, WI
07.2011 - 12.2018
- Acquired in-depth knowledge of company policies and procedures for claim processing and payment determination for both Disability Income claims and Life Waiver claims.
- Managed workloads by prioritizing tasks according to urgency and importance.
- Communicated decisions clearly to policyholders regarding claims outcomes.
- Reviewed and assessed claims to confirm coverage and validity.
- Utilized claims processing software to track and manage claim progress.
Customer Service Professional
Thrivent Financial
Appleton, WI
09.2007 - 07.2011
- Cultivated strong customer relationships through personalized attention and dedicated service.
- Ensured confidentiality compliance regarding sensitive customer information.
- Participated in training sessions to enhance knowledge of new products and services.
- Assisted with special projects to support team objectives.
- Conducted follow-up communications to guarantee customer satisfaction.
Education
Bachelor of Arts - Business Management
UW-Green Bay
Green Bay, WI05-2003
Skills
- Claims evaluation, audits, resolution strategies
- Regulatory compliance
- Risk assessment
- Client relationship management, conflict resolution
- Process improvement
- Effective communication skills
- Training and mentoring, team collaboration
- Interviewing techniques
- Organizational skills
- Insurance knowledge
References
References available upon request.
Timeline
Senior Claims Examiner/ Health Claims
Thrivent
01.2019 - Current
Claims Examiner/ Health Claims
Thrivent
07.2011 - 12.2018
Customer Service Professional
Thrivent Financial
09.2007 - 07.2011
Bachelor of Arts - Business Management
UW-Green Bay
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