Patrice Espeut
Houston,TX
Summary
Professional with significant experience in claims analysis and strong track record in team collaboration and achieving results. Skilled in risk assessment, claims processing, and regulatory compliance. Known for adaptability, problem-solving abilities, and clear communication. Prepared to contribute effectively to complex projects and support organizational goals.
Overview
11
11
years of professional experience
Work History
Senior Claims Analyst II
Elevance Health
Houston, USA
10.2018 - Current
- Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing
- Identifies the interdependencies of the resolution of claims errors on other activities within operations
- Assists in the reviews of state or federal complaints related to claims
- Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines
- Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved
- Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues
- Research and validate claims status throughout the recovery and appeals processing lifecycles within multiple Anthem claims and recovery systems
- Coordinates audit case status updates based on internal research and external feedback
- Identifies issues and trends in claims processing and brings them to the attention of the Manager
- Root Cause Analysis to determine claim denial trends and issues
Manager In Training
Midwest Petroleum INC
ST. LOUIS, USA
03.2014 - 10.2018
- Responsible for managing assigned store and maximizing potential sales and profitability
- Directs the efficient and effective functions of the entire store operation and ensure compliance of company policies and procedures
- Hire, train, and coach/counsel store staff under direction/approval of Supervisor
- Promote teamwork
- Ensure employee compliance with company policies and regulations
- Obey and enforce city, county, state, and federal laws in relation to store operation
- Maintain a safe store and property environment
- Follow all safety rules and regulations including reporting any employee or customer incidents within 24 hours
- Handle employee disciplinary and termination issues
- Conduct performance evaluations and pay increase recommendations
- Handle all customer complaints properly and to the satisfaction of the customer
- Account for all money received and disbursed
- Create employee schedules each week, manage overtime hours, and submit payroll weekly
- Review monthly profit and loss statement
Education
High School Diploma - General Studies
Soldan International Studies High School
St. Louis, MO05.2007
Skills
- Claims Processing Efficiency
- Strong negotiation skills
- Critical thinking abilities
- Professionalism and Integrity
- Statistical analysis techniques
- Strategic Decision-Making
Timeline
Senior Claims Analyst II
Elevance Health
10.2018 - Current
Manager In Training
Midwest Petroleum INC
03.2014 - 10.2018
High School Diploma - General Studies
Soldan International Studies High School