MELANIE HUBBARD
Humana
Blackstone,VA
8
years of professional experience
Professional with focus on claims evaluation and resolution. Adept at analyzing complex information, negotiating settlements, and ensuring compliance with regulations. Known for strong teamwork and adaptability, driving results in fast-paced environments. Skilled in customer communication, conflict resolution, and decision-making.
Work History
Claims Adjuster
2 Years 3 Months- Collaborated with claims adjusters and stakeholders to expedite claim settlements, enhancing client satisfaction and minimizing disputes.
- Guided clients in selecting personal lines insurance policies tailored to individual needs, ensuring informed decision-making.
- Processed policy applications and renewals efficiently, ensuring compliance with company guidelines.
- Resolved reimbursement issues through coordination with providers, members, and internal teams.
- Adjudicated complex medical claims using benefit plan provisions and claim-processing guidelines.
- Reviewed documentation for coding accuracy, eligibility, and policy compliance.
Claims Representative
2 Years 6 Months- Served as primary contact for customers throughout claims process, resolving concerns with empathy and professionalism.
- Assessed auto claims to establish coverage and liability per policy guidelines, ensuring accurate claim resolution.
- Facilitated settlements with claimants, attorneys, and other insurance carriers, effectively managing financial risk for the company.
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
Claims Representative
3 Years 1 Month- Resolved denied claims through payer follow-up and appeal preparation.
- Reviewed medical documentation to correct claim discrepancies and reduce rejections.
- Processed insurance claims, ensuring coding accuracy and timely submission.
- Verified patient coverage and benefits before service scheduling.
- Applied HIPAA standards while managing sensitive financial and insurance information.
Education
B.S - Human Resources Management
In Progress
Medical Office Professional Diploma - Medical Office
High School Diploma
Skills
Customer Service
Claims Investigation
Damage Assessment
Negotiation Expertise
Quality Assurance
Policy Analysis
Insurance Verification
Time Management
Escalation Handling
Underwriting Guidelines
Cold Calling
Highly motivated
Active listening
Claims investigation
Critical thinking
Timeline
Claims Adjuster
Humana
09.2023 - 12.2025Read More
Claims Representative
OB Gyn Associates HCA
03.2021 - 09.2023Read More
Claims Representative
InService America
02.2018 - 03.2021Read More
Central Senior High School
High School Diploma
Read More
American National University
Medical Office Professional Diploma from Medical Office
Read More
Liberty University
B.S from Human Resources Management
Read More