Lisa Turner
Sterling Heights,MI
Summary
Accomplished Claims Analyst for 13 years at Ascension Health Care, adept in claims analysis and fostering client relationships, significantly improved case resolution efficiency. Skilled in STARS and interpersonal communication, my critical thinking and settlement negotiation prowess have been pivotal in managing complex claims and enhancing team performance.
Overview
16
16
years of professional experience
Work History
Claims Analyst
Ascension Health Care
08.2011 - Current
- Managed medical malpractice caseload. In collaboration with assigned defense attorney.
- Maintained compliance with industry regulations and company policies while managing sensitive information and claims records.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Process of check requests for resolution of claims.
- Administrative follow-up per requests submitted by assigned defense counsel.
- Preparation and submission of National Practitioner Data Bank Reports.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Worked closely with legal counsel when necessary during complex cases involving litigation proceedings related to disputed claim outcomes.
- Assisted clients throughout the entire lifecycle of their claim, from initial filing to final settlement or denial determination.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Negotiated successful settlements with clients, ensuring a mutually beneficial outcome for all parties involved.
- Examined claims forms and other records to determine insurance coverage.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Researched claims and incident information to deliver solutions and resolve problems.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Reviewed questionable claims by conducting claimant interviews to determine if compensatory resolution is warranted.
- Reviewed security reports, medical treatment records, and physical property damage to determine extent of liability.
- Negotiated medical malpractice settlement agreements to resolve claims.
- Maintained claims data entered in STARS systems.
- Evaluated original investigation reports and documents to resolve concerns.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
Claims Coordinator
Ascension Health Care
09.2008 - 08.2011
- Risk Master/STARS entry of new claims.
- Organized and participated in claim review meetings.
- Claims data entry, ensuring proper documentation for future reference and audits.
- Contributed to departmental meetings by sharing insights gained from daily work experiences which helped improve overall team performance.
- Completion of National Practitioner Data Bank Reports.
- Process of check requests for payment of resolved settlements and defense invoices.
- File management of hard-copy documents.
Education
No Degree - Business
Davenport University
WarrenNo Degree - Nursing
Baker College
Clinton Township, MIHigh School Diploma -
John J. Pershing High School
Detroit, MI06.1989
Skills
- Accredited Claims Adjuster
- Claims analysis
- Interpersonal and written communication
- Policy Interpretation
- Proficient in STARS, Google and Microsoft programs
- Claim investigation
- Critical Thinking
- Customer service and support
- Computer Skills
- Active Listening
- Records Review
- Decision-Making
- Team Collaboration
- Settlement Negotiations
Licensed Claims Adjustor - Michigan
License is granted by the Director of the Department Of Insurance and Financial Services to engage in the business of Insurance. Subject to all applicable laws, regulations and rules.
Timeline
Claims Analyst
Ascension Health Care
08.2011 - Current
Claims Coordinator
Ascension Health Care
09.2008 - 08.2011
No Degree - Business
Davenport University
No Degree - Nursing
Baker College
High School Diploma -
John J. Pershing High School