Experienced Claims Adjuster offering five years of quality-driven expertise. Known for analytical skills and effective problem-solving, dedicated to ensuring accurate and efficient processing of claim issues big and small.
Overview
16
16
years of professional experience
Work History
Senior Customer Service Representative
UMR
11.2024 - Current
Assisted Providers over the phone with inquiries related to benefits, eligibility, authorizations, and claims.
Followed up on appeal, adjustment, and payment issues - escalating as needed to ensure issues are resolved promptly and correctly.
Clearly and thoroughly documented all communication in Calltrack.
Claims Adjuster (Claims Rep Sr)
Optum
08.2020 - 11.2024
This is the same role I was working under Mary Kraft. I was moved from a contract employee to an FTE with UHG.
Claims Adjuster (Claims Rep Sr)
Mary Kraft Staffing and HR Solutions
02.2020 - 08.2020
Researched and processed claims in accordance with Maryland Medicaid's state guidelines, utilizing various resources, documents, and tools to ensure high-quality processes while resolving complex claim issues.
Communicated claim outcomes and issues clearly and comprehensively via Task notes, which could be easily relayed to Providers and Participants.
Worked closely with teammates and other departments in the company to ensure that providers and Medicaid participants received the best possible experience for their insurance needs.
Identified gaps in our processes, proposed solutions, and streamlined our procedures to minimize errors.
Displayed proficiency with a variety of computer applications, such as Excel and Word Documents.
Maintained flexibility as inventory needs and processes changed frequently.
Claims Processor
Mary Kraft Staffing and HR Solutions
10.2019 - 02.2020
Processed insurance claims efficiently, demonstrating strong attention to detail.
Consistently met inventory processing goals and quality metrics.
Frequently took on new challenges when opportunities arose. For example, taking phone calls from providers to help them set up their Incedo Provider Portal and answer their claims-related questions surrounding the Beacon-Optum transition.
Volunteer Coordinator
Duluth-Superior Film Festival
03.2018 - 06.2019
Enlisted volunteers for the film festival.
Planned volunteer schedules and assigned responsibilities.
Communicated clearly with the volunteer staff to ensure everyone knew their jobs and what would be expected of them.
Consistently met inventory processing goals and quality metrics.
Frequently took on new challenges when opportunities arose.
Managed 20-30 volunteers and duties across several venues, while many events were happening simultaneously.
Ensured there was always appropriate staff coverage where necessary based on the festival schedule and attendance numbers.
Customer Service Representative/Insurance Producer
American Family Insurance
10.2015 - 10.2019
Calculated premiums and established payment method.
Performed administrative tasks, such as maintaining records and handling policy renewals.
Conferred with customers by telephone or in person to provide information about products or services, entered orders, canceled accounts, and obtained details of complaints.
Kept detailed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
Ensured that appropriate changes were made to resolve customers' requests.
Personal Care Assistant
Access North - Center for Independent Living of NE MN
07.2009 - 08.2015
As cooking, cleaning, washing clothes and dishes, and running errands.
Participated in case reviews, consulting with the team caring for the client to evaluate the client's needs and plan for continuing services.
Provided extra assistance at school for younger clients.
Attended to children's basic needs by feeding them, dressing them, and attending to their hygiene.
Provided a variety of materials and resources for children to explore, manipulate and use, both in learning activities and in imaginative play.
Education
High School Diploma -
Homeschooled
Duluth, MN
06-2009
Skills
Claims investigation
Problem Solving
Excel
Microsoft Word
Customer Service
Team Collaboration
Quality Assurance
Personal Information
Date of Birth: 07/25/91
Timeline
Senior Customer Service Representative
UMR
11.2024 - Current
Claims Adjuster (Claims Rep Sr)
Optum
08.2020 - 11.2024
Claims Adjuster (Claims Rep Sr)
Mary Kraft Staffing and HR Solutions
02.2020 - 08.2020
Claims Processor
Mary Kraft Staffing and HR Solutions
10.2019 - 02.2020
Volunteer Coordinator
Duluth-Superior Film Festival
03.2018 - 06.2019
Customer Service Representative/Insurance Producer
American Family Insurance
10.2015 - 10.2019
Personal Care Assistant
Access North - Center for Independent Living of NE MN
07.2009 - 08.2015
High School Diploma -
Homeschooled
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