Summary
Overview
Work History
Skills
Roles And Responsibilities
Timeline
Generic

Nicole Swinson

Peoria,AZ

Summary

Results-oriented Claim Business Process Consultant at United Healthcare, specializing in problem-solving and data analysis. Demonstrates success in optimizing operational efficiency and addressing intricate claims challenges. Proficient in stakeholder engagement and leveraging Power BI for actionable insights, driving enhanced financial performance and client satisfaction.

Overview

8
8
years of professional experience

Work History

Claim Business Process Consultant / VBR

United Healthcare
01.2023 - Current
  • Developed strategies to resolve issues impacting operational performance.
  • Conducted root cause analysis on complex problems affecting efficiency.
  • Resolved operational issues effectively, demonstrating strong problem-solving skills.
  • Managed processes for Value-Based and Capitated Provider groups, ensuring compliance with regulations.
  • Presented monthly performance data to stakeholders for informed decision-making.
  • Facilitates OEM and IPOC meetings, fostering collaboration for enhanced outcomes.
  • Monitored impacts on care providers and member experiences using Power BI, Excel, and PowerPoint.
  • Collaborated with executives to build and maintain transparent relationships with Delegates.

Data Mining

Optum
10.2022 - 01.2023
  • Conducted data mining activities to identify trends, issues, or discrepancies in financial data.
  • Helped in the writing and steps required for job aids needed to recover claims.

Investigations and Solutions/ISG

United Healthcare
08.2020 - 10.2022

Achieved measurable improvements in claim handling through resolution of provider issues.

Facilitated system updates to significantly boost operational efficiency.

Collaborated with cross-functional teams to implement effective solutions, enhancing provider relations.

Led provider meetings to ensure clear communication and comprehensive education.

Exceeded resolution metrics by demonstrating strong analytical problem-solving skills.

Platinum Adjuster / SME

United Healthcare
03.2017 - 08.2020
  • Processed claims for Gold Card members with precision and accuracy.
  • Resolved complex claims swiftly, reducing overall resolution time.
  • Guided team as Subject Matter Expert in interpreting standard operating procedures.
  • Facilitated collaboration during weekly partner meetings to enhance communication.

Skills

  • Problem solving
  • Time management
  • Interpersonal communication
  • Multi Platform User Experience
  • Excel
  • Power BI
  • PowerPoint
  • Data analysis
  • Analytical thinking
  • In-depth claim knowledge
  • Claims processing
  • Stakeholder engagement
  • Root cause analysis
  • Teamwork and collaboration
  • Problem-solving abilities
  • Claim knowledge, all lines of business

Roles And Responsibilities

  • Conducts root cause analysis with Power BI, deriving actionable insights for business processes.
  • Facilitates OEM and IPOC meetings, fostering collaboration for enhanced outcomes.
  • Efficiently resolves complex claim issues, ensuring client satisfaction and loyalty.
  • Partners with Delegates to align solutions with evolving business needs.
  • Analyzed data to identify overpayments, boosting financial outcomes with measurable results.
  • Conducted quality audits on claims, ensuring payment accuracy and minimizing overpayments.
  • Handled high-volume algorithm-based issues, enhancing operational efficiency.
  • Developed comprehensive job aids for algorithm processes, improving team knowledge.
  • Resolved provider issues, achieving measurable improvements in claim handling.
  • Facilitated system updates, boosting operational efficiency significantly.
  • Collaborated with teams for effective solutions, enhancing provider relations.
  • Led provider meetings, ensuring clear communication and education.
  • Exceeded resolution metrics, showcasing strong analytical problem-solving.
  • Processed claims for Gold Card Members with precision, enhancing accuracy.
  • Resolved complex claims swiftly, improving resolution time.
  • Guided team as Subject Matter Expert in SOP interpretation.
  • Facilitated effective collaboration in weekly partner meetings.
  • Boosted claim resolution efficiency through problem-solving.

Timeline

Claim Business Process Consultant / VBR

United Healthcare
01.2023 - Current

Data Mining

Optum
10.2022 - 01.2023

Investigations and Solutions/ISG

United Healthcare
08.2020 - 10.2022

Platinum Adjuster / SME

United Healthcare
03.2017 - 08.2020
Nicole Swinson