LISA KELLEY
Denver,CO
Summary
Results-driven Claims Examiner at Centivo with expertise in claims processing and fraud investigation. Proven ability to enhance workflow efficiency and train teams, leading to increased productivity. Strong communicator and detail-oriented professional skilled in data verification and customer service, adept at resolving discrepancies and ensuring compliance.
Diligent Claims Examiner with solid background in processing and evaluating insurance claims. Effectively managed numerous cases, ensuring accurate and timely resolution. Demonstrated strong analytical skills and attention to detail in complex claim assessments.
Overview
19
19
years of professional experience
Work History
Claims Examiner
Centivo
12.2021 - Current
- Evaluated claims for accuracy and completeness, ensuring compliance with company policies.
- Processed complex claims using advanced claims management systems to optimize workflow efficiency.
- Trained new staff on claims processing procedures and best practices.
- Increased productivity by implementing efficient strategies for handling high volumes of medical claims daily.
- Identified and resolved discrepancies between patient information and claims data.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Documented information gathered in field and uploaded data to company database for efficient processing using Javelina.
- Conducted thorough investigations into claims, identifying fraudulent activities and mitigating risks.
Sales Assistant
Air Purification Company
12.2006 - 03.2019
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Managed time efficiently in order to complete all tasks within deadlines.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Learned and adapted quickly to new technology and software applications.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
Education
Colorado Mountain College
Glenwood Springs, CO01-1984
Skills
- Claims processing
- Verbal communication
- Data verification
- Computer skills
- Payment processing
- Claims
- Denied claims identification
- Fraudulent claims investigation
- Benefits review
- Claims adjustment
- Teamwork
- Teamwork and collaboration
- Customer service
Timeline
Claims Examiner
Centivo
12.2021 - Current
Sales Assistant
Air Purification Company
12.2006 - 03.2019
Colorado Mountain College
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