Nicole Kann
Addison,IL
Summary
Meticulous Denial Specialist/Senior Claims Adjuster offering a 22-year track record conducting prompt, thorough investigations of health insurance claims. Well-versed in establishing proof of loss by studying medical documents, assembling additional information from outside sources and initiating and conducting investigations of questionable claims. Responsible and mature individual possessing sound decision-making and interpersonal skills. Also been a senior claims adjuster for over 22 years. Highly successful in multi-tasking with effectiveness and efficiency. Strong problem solving skills and, am very self- motivated. Known for being proactive and taking the initiative. Strive to meet and exceed expectations, and an accomplished team player. Meticulous Denial Specialist offering 22-year track record conducting prompt, thorough investigations of health insurance claims. Well-versed in establishing proof of loss by studying medical documents, assembling additional information from outside sources and initiating and conducting investigations of questionable claims. Responsible and mature individual possessing sound decision-making and interpersonal skills.
Overview
26
26
years of professional experience
Work History
Customer Experience Specialist
Abc Plumbing, Heating & Cooling
08.2022 - 01.2024
- Utilized telephone, online chat, and email platforms to deliver outstanding customer service.
- Documented customer interactions in internal database to maintain customer service history details.
- Responded to high volume of incoming calls utilizing listening and communication skills to identify customer problems, needs, and opportunities.
- Maintained extensive knowledge of company products to recommend items aligned with customer needs.
- Addressed customer inquiries, concerns, and complaints by providing solutions and alternatives and followed up to confirm resolution.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
Denial Specialist
Conifer Health
05.2019 - 07.2022
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Conducted in-depth analysis of inquiries and complaints to compose appeal letters for clients.
- Resolved medical claims by approving or denying documentation, calculating benefit due and initiating payment or composing denial letter.
- Reviewed provisions of certificates or policies to determine patient's medical coverage losses.
- Scanned hard copy medical records and correspondence to convert into electronic files.
- Documented medical claim actions by completing forms, reports, logs and records.
Senior Claims Adjuster
Trust
08.1997 - 02.2019
- Adjudicated Claims
- EOB’S
- Processed checks
- Payed claims in Life Pro, Payspan, and Onbase
- Received and made phone calls from insureds and medical professionals
- Trained new hires
- Daily duties included handing out work to staff of 6 adjusters
- Monitored their progress on daily basis
- Paid and processed claims up to $10,000
- Investigated fraud claims and led project team
- Answered customer services phone calls and emails along with accounting department
- Audited adjusters who were processing claims
- Assisted other departments such as CHS unit (Cancer, Heart Attack, and Stroke) with the paying of claims
- Worked closely with Under Writing department, answering questions regarding particular claims
- Have also been interim supervisor, and project lead
- Switchboard/Front Desk duties (answering calls and directing them to proper departments)
- Assisting visitors when coming into the office
- Assisting with customer service.
- Have also received many awards and accolades such as employee of the month
- Key performer several times
- Experience
Education
High School Diploma -
Mother Guerin
Chicago, IL06.1995
Skills
- Excellent administrative abilities
- Documentation abilities
- Patient contact
- Proficient in Ciox, ACE, Microsoft Office
- Account management
- Understanding of medical terms
- Reporting skills
- Insurance coverage verification
- Prior authorization processing
- Insurance industry experience
- Decision Making
- Self-Motivated
Timeline
Customer Experience Specialist
Abc Plumbing, Heating & Cooling
08.2022 - 01.2024
Denial Specialist
Conifer Health
05.2019 - 07.2022
Senior Claims Adjuster
Trust
08.1997 - 02.2019
High School Diploma -
Mother Guerin
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