Michael Fisher
Oxnard,CA
Summary
Knowledgeable Risk Analyst equipped with strategic planning and program leadership abilities honed in the health insurance industry environment. Familiar with regulatory requirements to maintain strict controls. Excellent quantitative and critical thinking abilities paired with knowledge of Microsoft Office Products. Dedicated to long-term risk management by building strong internal protocols and instilling culture of responsibility and attentiveness. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level financial analyst position. Ready to help team achieve company goals.
Overview
23
23
years of professional experience
Work History
Grievances and Appeals Risk Analyst
Elevance Health
09.2021 - Current
- Investigated allegations to check validity and recommend actions to minimize risk.
- Reviewed contracts and agreements to identify potential risks and ideal mitigation strategies.
- Completed statistical reviews to uncover trends, patterns and variations.
- Implemented financial risk management policies, limits and strategies that complied with standards and strategic imperatives of organization.
- Employed strong program management skills to successfully define and manage ongoing initiatives designed to control quality risks.
- Worked within Microsoft Excel to compile and review information with pivot tables and charts.
Health Insurance Medical Underwriter
Anthem Blue Cross Of California
10.2020 - 06.2021
- Utilized knowledge of insurance principles, policies and procedures to make decisions on risk assessment.
- Collaborated with other professionals to develop innovative underwriting solutions.
- Skilled at working independently and collaboratively in a team environment.
- Managed time efficiently in order to complete all tasks within deadlines.
Provider Pay Reconsider Claims Analyst
Anthem Blue Cross Of California
12.2017 - 09.2020
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Researched claims and incident information to deliver solutions and resolve problems.
- Documented information gathered in field and uploaded data to company database for efficient processing using Microsoft Excel.
Health Insurance Claims Processer
Anthem Blue Cross Of California
10.2014 - 12.2017
- Communicated through correspondence with members and providers regarding claim payment or required information,
- Completed daily documentation and communicated status of claims to adhere to reporting requirements.
- Verified benefits to each claim by using appropriate tools, processes and procedures.
- Met and maintained performance goals established for position in areas of quality, production and attendance.
- Posted payments to accounts and maintained records.
Medical Underwriter II
Anthem Blue Cross Of California
10.2008 - 12.2013
- Developed and implemented underwriting policies and procedures, establishing useful and accurate processing of applications.
- Evaluated applications to determine insurance coverage and appropriate risk classifications.
- Collaborated with other professionals to develop innovative underwriting solutions.
- Proven ability to learn quickly and adapt to new situations.
- Worked effectively in fast-paced environments.
Claims Quality Auditor II
Anthem Blue Cross Of California
02.2001 - 09.2008
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Processed and recorded new policies and claims.
- Used Microsoft Office systems to program, set up functions and enter data for claims.
Education
Business
Oxnard College
Oxnard, CASkills
- Stop-Loss Reporting Tools
- Risk Mitigation
- Pivot Tables
- Trend Analysis
- Order Reviewing
- Chart Development
- Database Management
- Data Entry
- Customer Communication
- Relationship Building
- Contingency Planning
Timeline
Grievances and Appeals Risk Analyst
Elevance Health
09.2021 - Current
Health Insurance Medical Underwriter
Anthem Blue Cross Of California
10.2020 - 06.2021
Provider Pay Reconsider Claims Analyst
Anthem Blue Cross Of California
12.2017 - 09.2020
Health Insurance Claims Processer
Anthem Blue Cross Of California
10.2014 - 12.2017
Medical Underwriter II
Anthem Blue Cross Of California
10.2008 - 12.2013
Claims Quality Auditor II
Anthem Blue Cross Of California
02.2001 - 09.2008
Business
Oxnard College