Summary
Overview
Work History
Education
Skills
Accomplishments
Additional Information
Timeline
Generic
MICHELLE DE LARA

MICHELLE DE LARA

Romeoville,IL

Summary

Dynamic Claims Processor with extensive experience at SEIU Benefit and Pension Funds, excelling in regulatory compliance and conflict resolution. Proven track record in enhancing team performance and accuracy in claims processing. Adept at building relationships and mentoring staff, ensuring high-quality service and operational excellence.

Overview

38
38
years of professional experience

Work History

Claims Processor

SEIU Benefit and Pension Funds
Chicago, IL
05.2025 - 10.2025
  • Reviewed documentation to ensure compliance with regulations and policies.
  • Collaborated with team members to resolve complex claim issues efficiently.
  • Processed a high volume of incoming claims in accordance with established policies and procedures.
  • Verified claim data correctness in preparation for processing.
  • Adhered to all applicable laws, regulations, and company standards while processing claims.
  • Analyzed contracts and claim systems to apply appropriate benefit amounts.
  • Performed additional duties as requested by management team.

Claims Auditor

Managed Care Staffers
Park Ridge, Illinois
09.2024 - 04.2025
  • Reviewed claims for accuracy and compliance with regulations.
  • Collaborated with claims adjusters to resolve complex issues efficiently.
  • Remained professional at all times, especially when speaking to customers or responding to messages to represent company's high level of service.
  • Assessed insurance claims and reviewed eligibility information for members to determine if payments had been properly made.
  • Reviewed and audited claims to identify errors or discrepancies in the documentation.
  • Analyzed claims processing errors, gleaning information to determine origin of issues and initiated corrective action.

Reimbursement Supervisor

Addus Healthcare
Downers Grove, USA
02.2017 - 04.2023
  • Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
  • Resolved customer complaints or answered customers' questions.
  • Coordinated with other supervisors, combining group efforts to achieve goals.
  • Guided employees in handling difficult or complex problems.
  • Reviewed AR for multi million dollar Insurance Companies.
  • Led Monthly meetings between Addus Healthcare and several MCO's.
  • Dealt directly with Managers/Directors to ensure metrics were met.
  • Maintained an excellent relationship with several Insurance Companies and their staff.
  • Problem solving/conflict resolution.

Medical Reimbursement Specialist

CERNER
Farmington, USA
02.2011 - 08.2016
  • Took billing calls, questions and concerns from patients and third party carriers.
  • Processed claims and forwarded information to Medicare, Medicaid and commercial insurance companies.
  • Entered patient charges and payments into electronic health records.
  • Identified discrepancies and carrier issues regarding billing and reimbursements.
  • Corrected, completed and processed claims for payer codes.
  • Coding and Resolution of claims.

Medical Insurance Supervisor

Destiny Healthcare
Oakbrook, USA
08.2005 - 08.2010
  • Worked with International Companies to ensure transition went smoothly (Company outsourced to South Africa).
  • Maintained Reports for Customer Service and Claims Teams.
  • Worked directly with Management to ensure numbers were met and goals achieved.
  • Coordinated with other supervisors, combining group efforts to achieve goals.
  • Resolved customer complaints or answered customers' questions.
  • Delegated work to staff, setting priorities and goals.

Claims/Customer Service Manager

United Healthcare
Matteson, USA
10.1987 - 01.2005
  • Established positive rapport with customers, managers and customer service team members to maintain positive and successful work environment.
  • Demonstrated excellent communication skills in resolving product and consumer complaints.
  • Maintained knowledge of company products and services to promptly resolve complaints and concerns.
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
  • Claims Examiner, Customer Service Representative, Team Lead, Supervisor and Manager Positions.

Education

Associate of Science - Healthcare Administration

Joliet Junior College
Joliet, IL
01.1985

Skills

  • Decision Making
  • New Hire Orientation
  • Regulatory Compliance
  • Relationship Building
  • Team Building
  • Team Leadership
  • Customer Service
  • Staff Development and Training
  • Handling Customer Complaints
  • Microsoft Office
  • Report Preparation and Analysis
  • Multitasking and Organization
  • Motivational Leadership
  • Coaching and Mentoring
  • Team Management and Supervision
  • Recruitment and Hiring
  • Quality Assurance
  • Performance Management
  • Claims processing
  • Claim documentation
  • Data verification
  • Compliance auditing
  • Conflict resolution
  • Team collaboration
  • Effective communication
  • Attention to detail
  • Time management
  • Payments posting
  • Accuracy and precision
  • Claims review
  • Claims trend analysis
  • Professionalism and ethics
  • Claims
  • Verbal and written communication
  • Denied claims identification

Accomplishments

  • Led team to achieve monthly bonus, earning recognition from upper management and financial reward.
  • Created highly effective new program that significantly impacted efficiency and improved operations.
  • Promoted from Team Lead to Manager in less than 12-months.
  • Managed 30 plus individuals.
  • Received many quality awards and bonuses.
  • Received employee of the month several times.
  • Enjoy working with people and guiding them to achieve their goals.

Additional Information

I have been in the Insurance Industry for 30 plus years. I have worked medical, dental, customer service and auditor positions. I am highly motivated and efficient in both Claims and Customer Service. I have worked with PPO, Medicaid, Medicare and multi plans. I feel I would be an asset to any Company looking for a dedicated, hard working individual.

Timeline

Claims Processor

SEIU Benefit and Pension Funds
05.2025 - 10.2025

Claims Auditor

Managed Care Staffers
09.2024 - 04.2025

Reimbursement Supervisor

Addus Healthcare
02.2017 - 04.2023

Medical Reimbursement Specialist

CERNER
02.2011 - 08.2016

Medical Insurance Supervisor

Destiny Healthcare
08.2005 - 08.2010

Claims/Customer Service Manager

United Healthcare
10.1987 - 01.2005

Associate of Science - Healthcare Administration

Joliet Junior College

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