Summary
Overview
Work History
Education
Skills
Timeline
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M'LYNN CONVERY

Taylor,USA

Summary

Detail-oriented and analytical Adjudication Associate with a proven track record in claims processing, compliance, and problem resolution. Efficiently manages high-volume adjudication tasks with a focus on accuracy. Demonstrated expertise in assessing claims, identifying discrepancies, and ensuring compliance with healthcare regulations. Seeks opportunity to leverage adjudication and customer support skills in a fast-paced role.

Overview

12
12
years of professional experience

Work History

Dental/Vision Claims Processor

Avesis
12.2024 - Current
  • Managed high volume of Commercial and Government claims, prioritizing tasks to meet deadlines without sacrificing quality
  • Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies
  • Worked alongside various groups to handle complicated claims challenges effectively.
  • Handled claim processing, data entry, and report generation through advanced applications.
  • Identified fraudulent claims through thorough investigation and documentation of findings

Medical Claims Processor

Sutherland
12.2023 - 12.2024
  • Authorize or reject Medicaid claims after thorough assessment.
  • Inspected medical documents in claims for critical data and identified discrepancies impacting claim processing.
  • Fostered in-depth familiarity with essential medical terms to better grasp offered services and processes.
  • Enhanced team collaboration, sharing best practices for efficient processing techniques
  • Ensured verification of insurance details for processing medical claims.
  • Identified and resolved discrepancies between patient information and claims data

Pharmacy Technician

Walgreens
09.2021 - 11.2022
  • Company Overview: Company Overview: Trenton
  • Resolved customer issues through in-person and telephone support for placing orders, navigating systems, and finding items.
  • Filled prescriptions adhering to strict accuracy standards.
  • Facilitated communication between patients and pharmacists concerning prescriptions and health issues.
  • Liaised with insurers to address concerns, ensuring smooth claims handling.
  • Conducted various pharmacy functions aimed at maintaining high standards of accuracy, efficiency, and service.

Injection Mold Operator/Team Lead

Yanfeng Automotive Interiors
05.2013 - 10.2021
  • Achieved 95% improvement in quality control by enhancing inspection processes and eliminating defects.
  • Modified tools to achieve higher productivity levels, contributing to a 10% increase in efficiency.
  • Minimized resource and time losses by addressing over 100 employee or production issues directly and implementing timely solutions
  • Cultivated effective and professional team member relationships to swiftly resolve over 50 issues.
  • Set high standards through personal example to clarify expected behaviors and standards, leading to a 20% increase in overall team performance.

Education

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Baker College
Allen Park, MI

Skills

  • Experience in pharmacy, managed care, Medicaid and/or Medicare organizations
  • Claims Verification Expertise
  • Strong and Analytical Problem Solver
  • Policy and Procedures Adherence
  • Data Entry and Database Maintenance
  • Advanced Computer Proficiency
  • Training and Development
  • Work Organizing and Prioritizing
  • ICD-10 Proficiency
  • Medical Terminology

Timeline

Dental/Vision Claims Processor

Avesis
12.2024 - Current

Medical Claims Processor

Sutherland
12.2023 - 12.2024

Pharmacy Technician

Walgreens
09.2021 - 11.2022

Injection Mold Operator/Team Lead

Yanfeng Automotive Interiors
05.2013 - 10.2021

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Baker College

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M'LYNN CONVERY