Robin Bannister
Chicago,,IL
Summary
Professional claims specialist with strong record in handling and resolving complex claims efficiently. Adept at analyzing data, identifying discrepancies, and providing solutions that drive positive outcomes. Effective team collaborator with focus on achieving results and adapting to evolving requirements. Passionate about delivering high-quality claims analysis, reducing financial discrepancies, and improving operational performance.
Overview
9
9
years of professional experience
Work History
Claims Specialist
Sedgwick
07.2023 - Current
- Process 250+ claims weekly, reducing claim rejection rates by 30% through enhanced verification protocols.
- Utilize claims management software to input, track, and manage claim statuses effectively.
- Investigate and resolved 95% of claim discrepancies within 48 hours, minimizing financial loss and ensuring member satisfaction.
- Conduct policy audits, ensuring 100% compliance with industry regulations and internal guidelines.
- Collaborate with adjusters and policyholders, expediting high-priority claims and reducing resolution time by 20%.
- Review and analyzed claims to ensure compliance with company policies and regulatory requirements.
Claims Analyst
Ranstad USA
06.2020 - 07.2023
- Analyzed complex medical claims to ensure compliance with regulations and policies.
- Increased claims approval accuracy by 20%, ensuring correct application of policy benefits and reducing disputes.
- Collaborated with healthcare providers to resolve discrepancies in claims processing.
- Provided exceptional customer service, addressing inquiries regarding coverage, benefits, and claim statuses promptly and professionally.
- Improved customer satisfaction by resolving complex medical claims in a timely and professional manner.
- Managed high-volume caseloads for optimal productivity while maintaining strict attention to detail, achieving an average 99.5% accuracy rate in claim assessments.
Case Building Specialist
Maximus
05.2018 - 06.2020
- Read and comprehended the exam request sent by the VA, and process it.
accordingly
● Checked veteran’s previous cases for overlapping information and other issues.
● Drafted and submitted clarification inquiries to the VA to better understand the information contained, or resolve any inconsistencies that exist, within the
exam request
● Ensured providers have the necessary documentation and medical records to properly evaluate veterans
● Researched medical conditions and new information when necessary.
● Identified and included all relevant worksheets and diagnostics requested by the VA.
● Appropriately drafted and formatted questions the VA would like the Provider to address.
Grievance Appeals Specialist
UnitedHealth Group
07.2016 - 05.2018
- Reviewed, researched, and understood how an authorization submitted by members and physicians/providers was processed and determined why it was denied.
- Identified and obtained all additional information (relevant medical records, contract language, and process/procedures) needed to make an appropriate determination of the appeal on the authorization.
- Completed the setup process of the appeal for the clinical team and the appeal coordinators to process and make a decision.
- Communicated appeal or grievance information to members or providers with the required timeframes
- Responded to and resolved customer service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits,
eligibility and claims, financial spending accounts, and correspondence. - Helped guide and educate customers about the fundamentals and benefits of
consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits, and choose a quality care
provider. - Contacted care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance.
- Assisted customers in navigating myuhc.com and other UnitedHealthGroup websites and encouraged and reassured them to become self-sufficient.
Education
Bachelor of Science - Political Science
Western Illinois University
Macomb, IL07-2016
Skills
- Claims processing
- Verbal communication
- Microsoft office
- Policy interpretation
- Time management
- Customer service
- Attention to detail
- Information verification
- Data entry
- Regulatory compliance adherence
- Medical terminology
- Organizational skills
- Verbal and written communication
- Conflict resolution
- CRM Systems
- Appeals handling
Timeline
Claims Specialist
Sedgwick
07.2023 - Current
Claims Analyst
Ranstad USA
06.2020 - 07.2023
Case Building Specialist
Maximus
05.2018 - 06.2020
Grievance Appeals Specialist
UnitedHealth Group
07.2016 - 05.2018
Bachelor of Science - Political Science
Western Illinois University