Max Dombi
Louisville,KY
Summary
Results-driven Claims Representative with over 5 years of expertise in claims research, resolution, and customer relations. Proven ability to handle escalations, analyze high-dollar accounts, and collaborate with insurers for optimal settlements. Committed to driving efficiency and enhancing customer satisfaction in a challenging role.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claims Research and Resolution Representative 4
Humana Inc.
11.2024 - Current
- Managed a diverse portfolio of clients, including 7 key providers, ensuring that each received tailored solutions aligned with their specific requirements.
- Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
- Optimized workflow processes, allowing for more efficient use of resources and reduced turnaround times on projects.
- Conducted detailed investigations into suspicious claims, reducing instances of fraud.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
Claims Research and Resolution Representative 4
Humana Inc.
06.2023 - 11.2024
- Improved decision-making processes with accurate data analysis and visualization techniques.
- Collaborated with cross-functional teams to ensure data integrity and accuracy, resulting in better-informed decisions.
- Enhanced business efficiency by identifying trends and patterns in complex datasets.
Claims Research and Resolution Representative 3
Humana Inc
06.2021 - 06.2023
- Manages claims operations that involve customer contact, investigation, and approval of settlements of claims for and against the organization
- Responsible for reviewing and resolving escalations from other representatives within the organization
- Used critical thinking to break down problems, evaluate solutions and make decisions.
Claims Research and Resolution Representative 2
Humana Inc.
06.2020 - 06.2021
- Collaborated with internal departments and external vendors to resolve claims.
- Processed insurance claims to ensure timely support for customers in need.
- Reviewed and analyzed claims for settlement and litigation processes.
- Negotiated with healthcare providers to resolve disputed claims, securing rightful payments.
Education
B.S. - Business Administration
Eastern Kentucky University
01.2025
A.S. - Business Administration
Eastern Kentucky University
01.2022
Skills
- Client relationship management
- Experienced with Microsoft Office applications
- Flexibility in work environments
- Client relationship building
- Effective time management
- Cross-functional team development
Certification
- Lean Six Sigma
Timeline
Claims Research and Resolution Representative 4
Humana Inc.
11.2024 - Current
Claims Research and Resolution Representative 4
Humana Inc.
06.2023 - 11.2024
Claims Research and Resolution Representative 3
Humana Inc
06.2021 - 06.2023
Claims Research and Resolution Representative 2
Humana Inc.
06.2020 - 06.2021
B.S. - Business Administration
Eastern Kentucky University
A.S. - Business Administration
Eastern Kentucky University
Similar Profiles
SHAWNESSY THOMPSONSHAWNESSY THOMPSON
Inbound Contact Representative II at Humana Inc.Inbound Contact Representative II at Humana Inc.
Perry ContrerasPerry Contreras
Customer Service Specialist at Humana Inc.Customer Service Specialist at Humana Inc.
GINA HILDRETHGINA HILDRETH
PREBOARDING SPECIALIST & HR CLIENT SERVICE DELIVERY at Humana Inc.PREBOARDING SPECIALIST & HR CLIENT SERVICE DELIVERY at Humana Inc.
Jina DesrosiersJina Desrosiers
RN/Case Manager at Humana Inc.RN/Case Manager at Humana Inc.
Ryan PenceRyan Pence
Mod Administrative Assistant at UPS Worldport Freight FacilityMod Administrative Assistant at UPS Worldport Freight Facility