Lisa Davidson
Rio Rancho,NM
Summary
Dynamic Claims Supervisor at BCBSNM with proven expertise in claims management and team leadership. Skilled in performance evaluation and employee training, I drive operational excellence and ensure compliance with contract standards. Adept at enhancing team productivity, I foster a culture of continuous improvement and deliver impactful results in claims processing.
Overview
12
12
years of professional experience
Work History
Claims Supervisor
BCBSNM (I.H.S. Dept)
Albuquerque, NM
10.2022 - Current
- As a Claims Supervisor, I lead and manage a team of claims technicians to ensure efficient and accurate processing of I.H.S. claims.
- Responsibilities include overseeing day to day operations providing guidance and support on complex claims.
- Ensuring adherence to policies and procedures and the I.H.S. contract
- Monitoring claims and pend workflows ensuring processing in a timely manner and within contract standards
- Collaborates with other teams to ensure satisfactory and efficient completion of claims
- Generate reports on team's performance and department metrics to management
Performance Specialist
BCBSNM (I.H.S. Dept)
Albuquerque, NM
09.2021 - 10.2022
- As the Performance Specialist, I focused on improving and optimizing employee performance by implementing adult learning theories and tailoring training classes.
- Conducted performance assessments and analyzed metrics to identify areas for improvement
- Collaborated with team supervisors to address areas of concern and gaps in learning and training
- Provided coaching and feedback to claims technicians
- Ensured documentation was updated as appropriate to enhance learning and allow for continued success following formal training
Quality Improvement Auditor
BCBSNM (I.H.S. Dept)
Albuquerque, NM
11.2015 - 09.2021
- As a Quality Improvement Auditor, I was responsible for evaluating performance within the department to ensure compliance with contract standards as well as accuracy of the claim payments
- Documented audits and identified areas of improvement and gaps in training
- Supported team supervisors with documentation and provided guidance and support to staff
Claims Analyst
BCBSNM (I.H.S. Dept)
Albuquerque, NM
11.2014 - 11.2015
- As a Claims Analyst, I was responsible for evaluating, processing, and manually pricing complex claims while ensuring accuracy and adherence to contract requirements.
- Reviewed and corrected discrepancies in complex claim processing and pricing which assisted with claims adjudication
Claims Examiner
BCBSNM (I.H.S. Dept)
Albuquerque, NM
05.2013 - 11.2014
- As a Claims Examiner, I was responsible for reviewing, investigating, and processing medical and dental claims to ensure they met contract standards.
- Verified claim details and ensured timely processing and accurate payments
Education
High School Diploma -
Cibola High School
Albuquerque, NM05-1985
Skills
- Claims management
- Performance evaluation
- Team leadership
- Employee training
- Quality assurance
- Claims processing
- Communication
- Adaptability
- Effective Time Management
- Detail-Oriented Organizational Abilities
References
References available upon request.
Timeline
Claims Supervisor
BCBSNM (I.H.S. Dept)
10.2022 - Current
Performance Specialist
BCBSNM (I.H.S. Dept)
09.2021 - 10.2022
Quality Improvement Auditor
BCBSNM (I.H.S. Dept)
11.2015 - 09.2021
Claims Analyst
BCBSNM (I.H.S. Dept)
11.2014 - 11.2015
Claims Examiner
BCBSNM (I.H.S. Dept)
05.2013 - 11.2014
High School Diploma -
Cibola High School
Similar Profiles
Derrick WrightDerrick Wright
Janitorial Lead at I.H.S ServicesJanitorial Lead at I.H.S Services
Oladayo AweOladayo Awe
Power Auditor at I.H.S Nigeria LtdPower Auditor at I.H.S Nigeria Ltd
OFILE DINTWAOFILE DINTWA
ADMINISTRATION OFFICER at I.H.S GABORONE-MINISTRY OF EDUCATION&SKILLS DEVELOPMENTADMINISTRATION OFFICER at I.H.S GABORONE-MINISTRY OF EDUCATION&SKILLS DEVELOPMENT