Hi, I’m
Maureen Alves
Mount Pleasant,PA
Summary
Accomplished professional with a proven track record at Knights Of Columbus Insurance, excelling in claims processing and customer service. Expert in data entry proficiency and adept at fostering teamwork and collaboration. Demonstrated success in enhancing claims accuracy by technical aptitude and problem-solving skills to streamline operations and exceed performance targets.
Overview
21
years of professional experience
Work History
Knights of Columbus Insurance
Claims Processor
12.2021 - 08.2024
Job overview
- Followed up with customers on unresolved issues.
- Evaluated accuracy and quality of data entered.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Managed workload and priorities to claims processing meet deadlines.
- Identified and reported potential fraud or abuse related to claims to protect system integrity.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Generated, posted and attached information to claim files.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Modified, updated and processed existing policies.
- Verified client information by analyzing existing evidence on file.
- Determined appropriateness of payers to protect organization and minimize risk.
Knights of Columbus Insurance
Conversion and Exchange Processor
12.2018 - 12.2021
Job overview
- Received, reviewed incoming documents and materials. Processing the conversion of term to life policies. and Exchanging Life products. Determining daily schedule according to changing daily work orders or specific customer needs. Processing Life, Annuity transactions including internal and external exchanges and Forego of Annuity's.
- Trained new production staff members on safe and efficient production procedures and proper operations.
- Met production targets and tight deadlines by collaborating closely with team members.
- Tested products for functionality or quality and troubleshot problems with products.
- Examined incoming materials and compared to documentation for accuracy and quality.
- Used problem solving skills to promptly and successfully address problems.
- Proven ability to develop and implement creative solutions to complex problems.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Knights of Columbus Insurance
Loan and Surrender Processor
08.2010 - 12.2018
Job overview
- Received and reviewed incoming documents and materials. Processing Loans and Surrendering life and annuity products.
- Processed according to changing daily work orders and specific customer needs.
- Trained new production staff members on safe and efficient production procedures and proper operations.
- Examined incoming materials and compared to documentation for accuracy and quality.
- Investigated processing errors resolving issues.
- Applied effective time management techniques to meet tight deadlines.
Knights Of Columbus Insurance
Dividend Processor
2004 - 2010 (6 years)
Job overview
- Received and reviewed incoming documents and materials. Processed Surrender of Dividend, Paid Up additional insurance and Partial withdrawals.
- Used problem-solving and issue-resolution skills to promptly and successfully address production problems.
- Examined incoming materials and compared to documentation for accuracy and quality.
- Collaborated with other departments to optimize production workflows.
- Tested products or subassemblies for functionality or quality and troubleshot problems with equipment, devices, or products.
- Met production targets and tight deadlines by collaborating closely with team members.
- Trained new production staff members on safe and efficient production procedures and proper machine operations.
- Made sure that products were produced on time and are of good quality.
- Skilled at working independently and collaboratively in a team environment.
Education
Quinnipiac University, Hamden, CT
Sacred Heart High School, Waterbury, CT
High School Diploma
06.1998
Skills
- Claims
- Medical terminology knowledge
- Data entry proficiency
- Claims review process
- Teamwork and collaboration
- Claim Amount calculations
- Insurance claim forms review
- Eligibility determination
- New policies processing
- Customer Service
- Problem solving
- Application review
- Time management
- Professionalism
- Adaptability and flexibility
Timeline
Claims Processor
Knights of Columbus Insurance
12.2021 - 08.2024
Conversion and Exchange Processor
Knights of Columbus Insurance
12.2018 - 12.2021
Loan and Surrender Processor
Knights of Columbus Insurance
08.2010 - 12.2018
Dividend Processor
Knights Of Columbus Insurance
2004 - 2010 (6 years)
Quinnipiac University
Sacred Heart High School
High School Diploma
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