Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

NAKAY FLYNN

Fort Lauderdale

Summary

Experienced Claims Adjuster and Fraud Analyst with expertise in personal claims, financial fraud, and disputes. Highly skilled in health insurance statutes, regulations, and practices. Adept at providing comprehensive risk assessments, transaction reviews to prevent fraud, and delivering superior customer service. Proven ability to manage claims, reconcile accounts, and prepare detailed reports on financial status.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Claims Research and Resolutions Representative 2

Humana
07.2024 - Current
  • Conduct pricing evaluations and handle clinical audits for accuracy and compliance
  • Review and adjust claims based on detailed assessments, ensuring proper coding and billing procedures
  • Collaborate with healthcare providers to resolve claim discrepancies and address inquiries
  • Perform in-depth analysis and resolution of claims to maintain operational efficiency and adherence to policies
  • Ensured adherence to regulatory codes with meticulous research prior to commencing drafting tasks.
  • Improved client satisfaction by efficiently managing insurance recovery claims and providing timely updates on progress.
  • Resolved complex billing discrepancies by conducting thorough research and working closely with insurance carriers to achieve timely resolution of outstanding claims.

Medicare Benefits Advocate

UnitedHealth Group
02.2022 - 04.2024
  • Delivered quality customer service by addressing inbound inquiries regarding claims, benefits, and eligibility
  • Applied medical necessity guidelines, resolved discrepancies, and implemented cost containment measures
  • Coordinated benefits with Medicare, Medicaid, and secondary insurances, ensuring compliance with coding and member identification processes
  • Remote

Disputes and Fraud Analyst

American Express
12.2018 - 07.2020
  • Provided "white-glove" customer service for credit card fraud and dispute claims
  • Acted as a liaison, offering best practice solutions to mitigate losses for American Express and its clients
  • Investigated customer accounts for fraudulent activity, escalating and resolving issues promptly
  • Delivered timely and accurate reporting on fraud trends, dispute volumes, and associated financial impacts to senior management.
  • Contributed to the development of educational materials aimed at increasing customer awareness about potential scams and risks associated with financial transactions.
  • Leveraged analytical skills to identify patterns indicative of organized crime or other sophisticated attacks against the organization's assets or customer's interests.
  • Evaluated new technologies and methodologies for potential implementation in the organization''s anti-fraud initiatives.
  • Coordinated closely with law enforcement agencies when appropriate, assisting in their investigations as needed.
  • Identified fraudulent activities through meticulous analysis of transaction data and trends.

Benefits and Claims Specialist

Aetna
07.2014 - 01.2018
  • Assisted providers, members, and brokers with inquiries on claims and benefit status
  • Analyzed claims to determine coverage, applied medical necessity guidelines, and coordinated benefits with other insurers
  • Ensured compliance with procedural coding, diagnosis, and pre-coding requirements

Education

Associate of Science - DMS

MIAMI DADE COLLEGE
01.2025

Skills

  • Claims Adjudication and Adjustment
  • Healthcare Claims Auditing
  • Fraud Detection and Risk Assessment
  • Clinical Audit Reviews
  • Insurance Policy Analysis
  • Medical Coding and Billing (CPT Codes, ICD-9/10)
  • Pricing and Cost Containment Strategies
  • Medicare and Medicaid Coordination
  • Data Analysis and Reporting

Certification

  • Anti-Money Laundering Foundations Certificate- ACAMS(Association Of Certified Anti-Money Laundering Specialists).
  • Life and Health Insurance License - Florida Department of Insurance.

Timeline

Claims Research and Resolutions Representative 2

Humana
07.2024 - Current

Medicare Benefits Advocate

UnitedHealth Group
02.2022 - 04.2024

Disputes and Fraud Analyst

American Express
12.2018 - 07.2020

Benefits and Claims Specialist

Aetna
07.2014 - 01.2018

Associate of Science - DMS

MIAMI DADE COLLEGE

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