Mary Styran
Pahrump
Summary
Detail-oriented Claims Adjustment Specialist with proven skills in claims analysis, data management, and regulatory compliance. Committed to enhancing efficiency and ensuring compliance in claims processing.
Overview
13
13
years of professional experience
Work History
Claims Adjustment Specialist
United Healthcare Group
Las Vegas
01.2013 - Current
- Analyzed claims for compliance with company policies and regulatory standards.
- Executed accurate data entry and management for all claim submissions.
- Reviewed policies to ensure alignment with current regulations and best practices.
- Identified process improvements that enhanced claims processing efficiency.
- Maintained accurate records of all claim activity in accordance with company policy and procedures.
- Reviewed and evaluated insurance claims to determine coverage and liability.
- Attended continuing education courses related to insurance industry regulations.
Claims Business Proc. Analyst, Sr.
UnitedHealth Group
Las Vegas
10.2020 - 09.2024
- Review, research, and respond to billing inquiries.
- Processed medical claims – Medicaid.
- Serves as a liaison between providers and members to solve balance billing issues.
- Ensured adherence to all policies and regulations.
- Determine and confirm member eligibility and benefits.
- The ability to recognize when complex reviews require supervisory guidance and support.
- Use pertinent data and facts to identify and solve a range of problems.
Claims Adjuster Specialist
UnitedHealth Group
Las Vegas
04.2018 - 09.2024
- Determine and confirm member eligibility and benefits.
- Prioritized and organized tasks to meet documented T.A.T.s.
- Ability to meet established productivity goals, schedule adherence, and quality standards.
- Prioritized and organized my own work deadlines.
- Enhanced customer satisfaction by providing timely and accurate claims resolutions.
Associate Enrollment/Eligibility Senior Representative
United Healthcare Group
Las Vegas
04.2015 - 10.2018
- Preparing, processing, and maintaining new member enrollment or group enrollments.
- Working with various types of member correspondence.
- Inventory control of member and group transactions.
- Reduced errors in eligibility determination through meticulous attention to detail and rigorous quality control measures.
- Streamlined workflow for faster application processing, resulting in improved turnaround times.
Health Advisor
United Healthcare
Chico
01.2013 - 02.2015
- Follow up on denied or unpaid claims.
- Possess a thorough knowledge and understanding of billing policies and procedures.
- Kept up on all the HIPAA laws and regulations.
- Verified patient eligibility for insurance coverage.
- Functioned as the primary contact for members by resolving problems, answering questions, and coordinating the needed information for other departments.
- Provided good customer service.
Education
BBA - Health Administration
University of Phoenix
Tempe, AZ04-2014
Associate of Science -
University of Phoenix
Tempe, AZ09-2011
Skills
- Claims analysis
- Data management
- Regulatory compliance
- Process improvement
- Claim evaluation
- Medical billing
Timeline
Claims Business Proc. Analyst, Sr.
UnitedHealth Group
10.2020 - 09.2024
Claims Adjuster Specialist
UnitedHealth Group
04.2018 - 09.2024
Associate Enrollment/Eligibility Senior Representative
United Healthcare Group
04.2015 - 10.2018
Claims Adjustment Specialist
United Healthcare Group
01.2013 - Current
Health Advisor
United Healthcare
01.2013 - 02.2015
BBA - Health Administration
University of Phoenix
Associate of Science -
University of Phoenix