Raven Smith

• Review and adjudicate claims in accordance with processing guidelines, consistently meeting quality and production standards.
• Determine and understand coverage provided under members’ health plans, ensuring accurate and timely resolution.
• Efficiently use multiple systems and screens to obtain and record claim information, contributing to streamlined processes.
• Identify claim cost management opportunities and refer claims for follow-up, optimizing overall claim resolution.
• Make claim payment decisions, enhancing customer satisfaction and retention.

• Processed a high volume of insurance claims daily, maintaining a 99% accuracy rate.
• Conducted thorough investigations to validate claims, resulting in a 20% decrease in disputed claims.
• Collaborated with legal teams to prepare documentation for claims litigation, achieving a 15% success rate in legal resolutions.
• Monitored claims trends and provided insights to underwriting teams for risk assessment.

• Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
• Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.

• Managed and resolved complex customer inquiries, achieving a 98% accuracy rate.
• Implemented a knowledge base for customer care representatives, resulting in a 20% reduction in resolution times.
• Conducted regular quality assurance audits of customer interactions, achieving a 98% compliance rate.
• Collaborated with product teams to address customer concerns, contributing to a 15% improvement in product enhancements.

• Contributed to positive work environment through effective teamwork and open communication with colleagues across departments.
• Participated in ongoing professional development opportunities to stay current on best practices in field of caregiving.