Octavia Brown
Roswell,USA
Summary
Dynamic and results-driven professional with extensive experience in claims management, customer relations, and community health programs. Skilled in building strong customer relationships, optimizing processes for improved efficiency, and delivering exceptional client service. Adept at analyzing complex data and implementing effective solutions to meet organizational goals. A motivated team player with a strong commitment to enhancing customer satisfaction and driving healthcare improvements.
Overview
8
8
years of professional experience
Work History
Claims Specialist
State Farm
03.2024 - Current
- Utilize various technologies to enhance efficiency and accuracy in claims processing.
- Collaborate with management to handle 75% of catastrophe claims resulting from natural disasters.
- Analyze complex claims to find cost-efficient payouts.
- Maintain strong remote team relationships based on trust and accountability.
- Manage a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Delivered comprehensive training sessions for new hires on claims handling procedures, policy interpretation basics, negotiation techniques, and other core competencies related to the role of a Claims Specialist.
Service Representative
Paychex Inc.
03.2022 - Current
- Enforced payroll-related policies and regulations, achieving a 95% accuracy rate in payroll processing.
- Trained and onboarded new employees, reducing errors by 50% in the first month.
- Managed a portfolio of 100+ accounts, ensuring excellent customer service with a 95% satisfaction rating.
- Processed 200+ employee records for accurate benefits enrollment, cutting errors by 20%.
- Delivered ongoing product education, resulting in a 20% increase in sales team knowledge.
- Provided ongoing coordination and monitoring to assure timelines, reports and contract requirements.
Care Coordinator
United Healthcare
10.2017 - 03.2024
- Developed a comprehensive community outreach program educating populations on chronic illness prevention.
- Implemented tracking systems for Medicare and Medicaid programs, reducing costs by 20%.
- Executed health management activities to ensure regulatory compliance, increasing member satisfaction by 20%.
- Collaborated with local service providers to enhance access to services, improving retention rates by 15%.
- Analyzed population health issues to improve patient engagement and healthcare understanding for early intervention.
- Implemented streamlined tracking systems for Medicaid/Medicare data to ensure credential compliance and reduced administrative costs by 20%.
- Early intervention specialist for preventive health issues.
- Maintained, updated, and managed EI service provider records to ensure compliance with state and federal requirements.
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
Education
Master's of Business Administration -
Capella University
01.2023
Master's of Science - Healthcare Administration Management
University of Maryland
01.2017
Skills
- Customer Relationship Management
- Claims Processing
- Community Outreach
- Process Optimization
- Payroll Compliance
- Cross-Functional Collaboration
- Training and Development
- Project Management
- Data Analysis
- Microsoft Office Suite (Excel, Word, PowerPoint)
- Verbal communication
- Claims investigation
- Microsoft office
- Coverage assessments
- Policy interpretation
- Compliance management
- Documentation review
- Inspection report review
- Negotiation leadership
- Time management
- Decision-making
- Critical thinking
Timeline
Claims Specialist
State Farm
03.2024 - Current
Service Representative
Paychex Inc.
03.2022 - Current
Care Coordinator
United Healthcare
10.2017 - 03.2024
Master's of Science - Healthcare Administration Management
University of Maryland
Master's of Business Administration -
Capella University
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