Summary
Overview
Work History
Education
Skills
Languages
Timeline
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Sandy Lachowsky

Kirkland,WA

Summary

Accomplished insurance professional with expertise in appeals, dispute resolutions, subrogation, and claims investigations. Skilled in negotiation and claims analysis, with a solid grasp of medical terminology. Committed to collaboration and continuous learning in a team-oriented environment.

Overview

30
30
years of professional experience

Work History

Appeals Specialist

Healthcare Management Administrators
03.2019 - 04.2025
  • Managed a substantial caseload of provider appeals. Approximately 20 incoming customer service emails, internal emails, and 15-40 new assigned appeal cases daily.
  • Developed personal standardized procedures to enhance efficiency in managing assigned cases.
  • Assisted in creating letter templates for streamlining more common appeal determinations and efficiency.
  • Acted as a resource on appeals matters, responding promptly to customer service inquiries.
  • Handled open negotiations under the Federal Balance Billing Act.
  • Used pricing software to price Tribal claims for reimbursement.
  • Assisted in adopting and refining processes by sharing insights from experiences working on various appeals cases with management.
  • Optimized internal communication channels between departments to ensure seamless coordination on complex appeals cases requiring input from multiple sources.
  • Demonstrated attention to detail when evaluating documentation in order to identify discrepancies or inconsistencies that could impact an appeal's outcome positively or negatively.

Subrogation Coordinator

Northwest Administrators Inc.
07.2009 - 11.2018
  • Maximized recoveries by negotiating settlements regarding third-party claims.
  • Enhanced workflow in the subrogation department through targeted process improvements. Including training staff on how to target a potential third-party claim.
  • Mentored junior staff, promoting skill development and team cohesion.
  • Cultivated strong partnerships with attorneys and insurance adjusters for effective collaboration on settlements.
  • Utilized comprehensive claim data or medical records to target potential subrogation cases effectively.
  • Consistently provided updates on case statuses through responsive communication through emails, phone calls, or faxes.
  • Assessed motor vehicle accidents, workplace injuries, and third-party liability claims thoroughly.

Consumer Affairs Officer

State Department of Insurance
06.1995 - 12.2008
  • Responsible for assigned complaints, disputes, and grievances by researching insurance contracts and regulatory laws for a timely written response.
  • Assisted and acted as a health insurance subject matter expert in the special investigations unit.
  • Addressed individual consumer complaints against insurance companies, agents, third parties, and practitioners in all lines of business.
  • Cultivated relationships with regulators, ensuring transparency in operations.
  • Assisted consumers regarding insurance contract questions and coverage interpretations by answering calls on assigned phone coverage days and providing walk-in consumer assistance.
  • Interpreted Idaho Code and relevant regulations, collaborating with the Attorney General's Office when necessary for understanding.
  • Delivered written responses to consumer complaints, as assigned through the department or the governor's office.
  • Contributed as a committee member in assessing existing health insurance laws for possible code revisions.
  • Collaborated with the insurance sector on legislative changes throughout the year.
  • Provided expert guidance on complex regulatory matters, enabling informed decision-making within the organization.
  • Keep informed regarding pending industry changes, trends, or best practices.

Education

Wenatchee High School
Wenatchee, WA

Wenatchee Valley Junior College
Wenatchee, WA

Skills

  • Appeals process knowledge
  • Teamwork collaboration
  • Decisive decision-making ability
  • Conflict resolution
  • Effective communication skills
  • Medical terminology & Coding knowledge
  • TPA/ERISA versed
  • Claims investigations
  • Interpersonal effectiveness
  • Commitment to ongoing learning
  • Subrogation processes
  • Negotiations of the Federal Balance Billing Act
  • Negotiated subrogation settlements

Languages

English

Timeline

Appeals Specialist

Healthcare Management Administrators
03.2019 - 04.2025

Subrogation Coordinator

Northwest Administrators Inc.
07.2009 - 11.2018

Consumer Affairs Officer

State Department of Insurance
06.1995 - 12.2008

Wenatchee High School

Wenatchee Valley Junior College

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Sandy Lachowsky