Lindsay DeVillers
De Pere
Summary
Experienced with analyzing and processing insurance claims, ensuring accuracy and compliance. Utilizes effective communication to resolve disputes and provide clear explanations to providers and internal partners. Knowledge of industry regulations and best practices to deliver fair and timely claim resolutions.
Overview
16
16
years of professional experience
Work History
Claims Adjustment Representative
UnitedHealth Group
03.2023 - Current
- Review and research provider claim reconsideration requests for Optum Care Medicare Advantage and Medicaid plans
- Apply knowledge of current policies and procedures to claim adjustments and respond to provider with details
- Collaborated with cross-functional teams to enhance overall operational efficiency in the claims department.
- Initiated process improvement initiatives by identifying areas of inefficiency or inconsistency in claim handling procedures and recommending solutions.
- Achieved consistent success in meeting or exceeding performance and quality metrics for claims processing speed and accuracy.
Intake Processor
UnitedHealth Group
02.2021 - 12.2021
- Reviewed and organized documents related to subrogation cases for UHC Commercial and Community and state plans
- Created cases/files for subrogation teams and ensured accurate information had been provided
- Organized incoming subrogation referral emails and triaged accordingly
Pre-Payment Subrogation Analyst
UnitedHealth Group
03.2019 - 02.2021
- Initiated and received phone calls to and from members, providers, attorneys, and insurance companies to gather coordination of benefits data and assist with subrogation process
- Exhibited strong analytical skills in evaluating claim files for potential third-party liability exposure, significantly reducing financial losses for UHC Commercial and Community and State Clients
- Assisted in developing departmental policies and procedures, ensuring compliance with state regulations and client requirements.
- Processed and adjusted claims in processing system to coordinate with auto and workers compensation insurance payments
Community & State Claims Adjuster/SME
UnitedHealth Group
02.2009 - 09.2017
- Reviewed and processed adjustment requests for single claims, projects and escalated requests from providers and internal partners for UHC Community and State plans
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Assisted supervisor as SME with additional job tasks/goals including reporting and inventory management
- Trained new employees on claims processing procedures, contributing to a well-prepared workforce.
- Contributed to the development and implementation of new procedures, policies, or guidelines that improved claim processing efficiency across the organization.
Education
Bachelors of Arts - English/Creative Writing
University of Wisconsin Eau Claire
Skills
- Claims investigation
- Dispute resolution
- Process Improvement
- Microsoft office
- Training
- Data Analysis
- Facets
- Team collaboration
- Enterprise Now
- Multitasking and organization
- Attention to detail
- Critical thinking
Timeline
Claims Adjustment Representative
UnitedHealth Group
03.2023 - Current
Intake Processor
UnitedHealth Group
02.2021 - 12.2021
Pre-Payment Subrogation Analyst
UnitedHealth Group
03.2019 - 02.2021
Community & State Claims Adjuster/SME
UnitedHealth Group
02.2009 - 09.2017
Bachelors of Arts - English/Creative Writing
University of Wisconsin Eau Claire
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