Summary
Overview
Work History
Education
Skills
Timeline
Generic
Matthew Wolarik

Matthew Wolarik

Health Insurance Professional
Northridge, CA,CA

Summary

I am a health insurance professional who currently works as a Grievance and Appeals Analyst for Anthem Inc. My 19-year career has spanned experience in customer service, claims, auditing, benefit coding, claims adjudication, business analysis, and grievance and appeals. Being in this industry for 19 years, I understand the need to have the ability to adapt to an ever-changing environment. My well-rounded background has provided me the ability to work well under pressure, handle complex challenges, and achieve goals in a fast-paced environment. What defines me is my strong belief in accountability, integrity, the power of team building, collaborative learning, and process improvement. What drives me is knowing that the work we do at Anthem directly impacts people on both the provider and member side daily. Anthem has provided me with the knowledge and experience to deliver an exceptional customer experience. I take pride in delivering that experience because I know it makes a difference for the people that we serve.

Overview

19
19
years of professional experience

Work History

Grievance and Appeals Analyst

Anthem Inc.
Woodland Hills, CA
2015 - Current
  • Review, Analyze and process pre and post service grievance and appeals.
  • Interpret evidence of coverage and provider contract language.
  • Correspond with state/federal regulators, providers, members, attorneys.
  • Manage department inventory.
  • Identify trends.
  • Coach less experienced analysts.

Business Analyst/Benefits Application Analyst

Anthem Inc.
Woodland Hills, CA
2010 - 2015
  • Served as liaison between business and IT.
  • Documented business requirements.
  • Translated complex business needs into application software requirements.
  • Assisted in the development of project plans.
  • Programmed claims adjudication.
  • Coded benefit contracts.
  • Executed user acceptance testing for multiple projects.

Provider Dispute Resolution Analyst

Anthem Inc.
, Woodland Hills, CA
2007 - 2010
  • Reviewed, analyzed, and processed provider administrative and clinical appeals.
  • Reviewed a minimum of 23 provider appeals per day.
  • Resolved escalated provider issues.
  • Inspected claims processing errors.
  • Adjusted claims.
  • Validated correct benefit administration.
  • Explained reimbursement policies to providers.
  • Collaborated with management on process improvement.

Quality Auditor

Anthem Inc.
, Woodland Hills, CA
2006 - 2007
  • Evaluated quality of services and interactions provided by organizations within the enterprise.
  • Documented and reported transaction/communication errors to ensure prompt resolution.
  • Tracked and trended audit results providing feedback to management.
  • Facilitated meetings to review audit findings.
  • Educated claims and customer service on company processes and polices.

Customer Care Associate I/II/III/Sr

Anthem Inc.
Woodland Hills, CA
2002 - 2006
  • Addressed customer concerns via phone and correspondence.
  • Resolved benefit and claim inquires for customers.
  • Reviewed a minimum of 75 customer inquiries per eight hours shift.
  • Assisted in training new associates.

Education

Associate of Science - Database Applications

American Public University
Charles Town, WV
11.2015 - 11.2017

Bachelor of Science - Business; Workforce Development

William Woods University
12.2019 - 12.2021

Skills

Researchundefined

Timeline

Bachelor of Science - Business; Workforce Development

William Woods University
12.2019 - 12.2021

Associate of Science - Database Applications

American Public University
11.2015 - 11.2017

Grievance and Appeals Analyst

Anthem Inc.
2015 - Current

Business Analyst/Benefits Application Analyst

Anthem Inc.
2010 - 2015

Provider Dispute Resolution Analyst

Anthem Inc.
2007 - 2010

Quality Auditor

Anthem Inc.
2006 - 2007

Customer Care Associate I/II/III/Sr

Anthem Inc.
2002 - 2006
Matthew WolarikHealth Insurance Professional