Ronda Wauls
Menifee,CA
Summary
Results-driven professional with expertise in claims investigation and financial acumen, honed at LIBERTY Dental Plan. Proven track record in mentoring teams and enhancing negotiation strategies, leading to improved outcomes. Recognized for attention to detail and problem-solving skills, ensuring compliance and accuracy in claims processing and audits.
Overview
17
17
years of professional experience
Work History
Claim Examiner
LIBERTY Dental Plan
Irvine, CA
11.2019 - Current
- Conducted thorough investigations into complex claims, gathering detailed evidence and interviewing involved parties to reach fair conclusions.
- Mentored junior staff members on effective negotiation strategies, helping them achieve better outcomes for both policyholders and the company itself.
- Collaborated with medical professionals to verify treatment plans and ensure proper reimbursement levels.
- Analyzed data trends to identify areas for improvement in claims handling procedures and adjuster performance.
Claims Auditor
United Healthcare Group
Buena Park, CA
03.2012 - 10.2019
- Identified fraudulent activities by conducting detailed audits on suspicious claims, protecting company resources.
- Participated in ongoing professional development opportunities to stay current on industry trends, enhancing personal skill set and benefitting the organization.
- Improved customer satisfaction by providing timely and accurate feedback on submitted claims, facilitating a positive experience.
- Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues.
Accounting Analyst
Masimo
Irvine, CA
02.2008 - 03.2012
- Maintained up-to-date knowledge of accounting regulations, industry standards, and best practices through continuous professional development activities.
- Enhanced financial accuracy by conducting thorough analysis and reconciliation of accounts.
- Assisted external auditors during annual reviews, providing detailed documentation and clarification on complex accounting issues.
- Organized [Type] and [Type] financial statements and assessed cash activities to verify proper usage of organizational funds.
Education
High School Diploma -
Leuzinger High School
Lawndale06-1989
Skills
- Claims investigation
- Policy interpretation
- Financial acumen
- Problem-solving
- Teamwork and collaboration
- Microsoft Office Suite
- Attention to detail
- Negotiation
Timeline
Claim Examiner
LIBERTY Dental Plan
11.2019 - Current
Claims Auditor
United Healthcare Group
03.2012 - 10.2019
Accounting Analyst
Masimo
02.2008 - 03.2012
High School Diploma -
Leuzinger High School
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