LORIE M. DAVIS
Louisville,KY
Summary
Secure a responsible career opportunity to fully utilize my training and skills, while making a significant contribution to the success of the company. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
12
12
years of professional experience
1
1
Certification
Work History
KP Recovery Specialists
The Phia Group
01.2024 - Current
- Investigate and pursue recoveries and payables on subrogation claims
- Recovery and resolutions for health plan, Commercial, and Government entities
- Initiate phone calls to members, providers, and other insurance companies to gather Coordination of Benefits data
- Ensure adherence to state and federal compliance requirements
- Place all parties are updates and complaint based on the client’s expectations in accordance with state laws
- Client calls to resolve any issues that may arise.
Investigation Team Leader
Optum (Formerly Equian)
01.2016 - 01.2024
- Obtain data relevant to investigations/overpayment identifications
- Perform research/verification of identified claims to identify payment/overpayment issues/accuracy
- Enter information into applicable systems to track processing of claims
- Complete file set up on subrogation/work compensation cases
- Knowledge of healthcare coding practices (ICD-9, ICD-10, CPT’s)
- Understanding of how to read and interpret medical records
- Back-up for all clients
- Act as a technical resource
- Handle projects as assigned
- Seen as a key team member
- Work to meet objectives
- Act as a facilitator to resolve conflicts on our team
- Prepare and maintain various reports
- Identify and execute the necessary process adjustments to processes
- Training all team members on all new procedures or products.
Customer Service Representative
Circle K
01.2019 - 01.2023
- Responsible for balancing out cash drawer at the end of each shift and submitting receipts to management
- Assisted in receiving and setting up sales floor marketing displays
- Assisted customers in cashing in and purchasing lotter tickets
- Counted and stocked different types of merchandise to comply with inventory control
- Skilled in delivering exceptional customer service by actively listening, understanding needs, and providing timely and effective solutions.
Claims Support Specialist
Equian
01.2013 - 01.2016
- Data entry of new files for damaged parties
- Data entry of all claims information to existing files
- Research directed by Examiner or Supervisor (online, details, demographic) for a specific client
- Retrieving and sending documents to be scanned to the appropriate file
- Responsible for all maintenance of service equipment
- Backup for 3 or more additional clients
- Knowledgeable of paperless importing and exporting data to Onbase
- Special Data Projects when needed.
Education
Bachelors Business Management -
Indiana Wesleyan University
Louisville, KY01.2007
Skills
- Claims Processing
- Data entry proficiency
- Follow-up skills
- Stress Tolerance
- HIPAA Compliance
- Multitasking and Organization
- Customer Service
- EMR
- Problem-Solving
- Team Leadership
Certification
Project Management
Clubinvolvement
ToastMasters, Trover Solutions, Louisville, KY
Training
- Stars Achievement Leadership Level I and II
- Competent Communicator from Toastmasters
Timeline
KP Recovery Specialists
The Phia Group
01.2024 - Current
Customer Service Representative
Circle K
01.2019 - 01.2023
Investigation Team Leader
Optum (Formerly Equian)
01.2016 - 01.2024
Claims Support Specialist
Equian
01.2013 - 01.2016
Bachelors Business Management -
Indiana Wesleyan University
Project Management
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