Summary
Overview
Work History
Education
Skills
Affiliations
Timeline
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Robyn Fekete

Steger,Illinois

Summary

Proficient Claim Analyst with experience handling and resolving critical quality problems using research abilities. Strong analytical, organizational and planning abilities. Consistently works with minimum supervision. Independent and self-directed.

Overview

36
36
years of professional experience

Work History

Integration Quality Analyst

Evolent Health
Chicago, IL
08.2018 - 12.2022
  • Maintained quality assurance procedure documentation via Zephyr software.
  • Audited completed test cases and provided feedback to team and plan building.
  • Created claim testing templates that were able to be used on all clients with minimal alterations.
  • Demonstrated an understanding of requirements and design/correlate to testing approach.

Claim Analyst

Evolent Health/Cicerone
Chicago, IL
10.2011 - 04.2018
  • Monitored in-bound and out-bound vendor claims for accumulator discrepancies.
  • Maintained plan changes to match correct cost-shares during each rate of coverage.
  • Loaded carry-over accumulators for cost-share credit when taking over new plans mid-year.
  • Ran claim reports to identify errors in cost-share applications.
  • Identified and rectified claim recalculations due to incorrect processing or plan changes.
  • Processed Medicare, Medicaid, Dental, Vision, TPL plans and Obamacare.
  • Handled management sensitive files.
  • Completed DOI, GA and client appeals.

Claim Specialist

Allied Benefit Systems Inc.
Chicago, IL
11.2003 - 09.2011
  • HRA processor and trainer.
  • Tested new clients before go-live to ensure benefits and cost-share were loaded correctly.
  • Mentored new hires to assist them in achieving their goals.
  • Processed TPA claims and coordinated benefits with Medicare and other primary insurance carriers.
  • Reimbursed Medicaid claims.
  • Regularly earned bonuses for exceeding job expectations.

HR Assistant

Trinity Services Group
Joliet, IL
07.2001 - 09.2003
  • Maintained database for all new hires and terminated employee files.
  • Sold Guardian Life Insurance plans and Aflec.
  • Signed up members for Kid Care (All Kids).
  • Reconciled all monthly insurance billing statements.
  • Authored an ABRA training manual.

Claims Processor/Trainer

Prudential/Aetna
Richton Park, IL
06.1987 - 06.2001
  • Liaison to client benefit administrators.
  • Provided suspense analysis resulting in an 81% in auto-adjudication.
  • Regularly earned quality and production bonuses.
  • Claim adjudication and recalculations.

Education

High School Diploma -

Bloom Trail High School
Chicago Heights, IL
06.1984

Skills

  • Strong communication skills
  • Identifies cost-saving measures to remain profitable in today's market
  • Excels in a varied work assignment
  • Team player with a can do attitude

Affiliations

  • Member of the American Cancer Society Relay for Life, Crown Point Indiana Chapter.

Timeline

Integration Quality Analyst

Evolent Health
08.2018 - 12.2022

Claim Analyst

Evolent Health/Cicerone
10.2011 - 04.2018

Claim Specialist

Allied Benefit Systems Inc.
11.2003 - 09.2011

HR Assistant

Trinity Services Group
07.2001 - 09.2003

Claims Processor/Trainer

Prudential/Aetna
06.1987 - 06.2001

High School Diploma -

Bloom Trail High School

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Robyn Fekete