Sarah Spires
Felicity,OH
Summary
Accomplished Business Analyst with expertise in data analysis and claims research. Enhanced service delivery by optimizing processes and maintaining proficiency in various claims research process systems. Ready to make an impact with an eagerness to learn new skills combined with using already gained knowledge of investigative detail and problem-solving skills.
Overview
18
18
years of professional experience
Work History
Business Analyst
The Elevance Health Companies, Inc
08.2018 - Current
- Analyzed business processes to identify areas for improvement and optimize efficiency.
- Developed comprehensive reports to support strategic financial planning.
- Collaborated with cross-functional teams to implement data-driven solutions enhancing service delivery.
- Assisted in streamlining workflows, resulting in improved project timelines and resource allocation.
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Boosted team productivity by introducing new capabilities using the Macro pre-price and adjudication process.
- Developed customized reports, summarizing and presenting data in visually appealing format.
- Analyzed data to identify root causes of problems and recommend corrective actions.
- Conduct internal audits of individual team members and report findings to the manager.
- Lead for all Medicare claims Macro submissions.
Claim Representative III
The Anthem Companies, Inc
02.2015 - 08.2018
- Processed and adjudicated insurance claims efficiently, ensuring compliance with company policies and regulations.
- Collaborated with healthcare providers to gather necessary documentation for claim resolution.
- Resolved complex claim disputes by conducting thorough investigations and negotiations with stakeholders.
- Mentored junior staff on best practices for claims processing and customer service techniques.
- Prioritized workload effectively under pressure, consistently meeting deadlines without sacrificing quality or accuracy in claim processing tasks.
- Decreased claim processing time by streamlining workflows and implementing efficient task prioritization.
- Analyze reports to submit for high dollar and claim volume adjustments.
Claims Representative Associate II
The Wellpoint Companies, Inc
02.2012 - 11.2015
- Processed and evaluated claims to ensure compliance with company policies and regulatory standards.
- Conducted thorough reviews of claim submissions, identifying discrepancies and initiating corrective actions.
- Conducted thorough investigations by gathering relevant information from various sources.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Developed in-depth understanding of insurance policies and procedures.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Customer Service Representative Member Relations
Wellpoint Companies Inc
10.2010 - 02.2012
- Managed high-volume calls efficiently, ensuring timely responses and accurate information delivery to clients.
- Developed comprehensive knowledge of company products, enabling precise guidance for customer needs and concerns.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Assisted customers in navigating the company website and improving overall user experience.
- Resolved customer inquiries enhancing satisfaction through effective communication and problem-solving skills.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from members.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Promoted to be a part of the new Claims Hybrid team to improve first call resolution by solving claims issues for members.
Customer Service Representative Provider Relations
National Government Services, Inc
11.2007 - 10.2010
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Managed high-volume call center operations, ensuring timely and accurate responses to client needs.
Education
No Degree - Criminal Justice
Northern Kentucky University
Newport, KYNo Degree - Criminal Justice
University of Cincinnati Clermont College
Batavia, OHSkills
- Data analysis
- Team collaboration
- Microsoft Office Excel
- Project management
- SQL proficiency
- Process optimization
- Internal auditing
- Problem-solving
- Attention to detail
- Multitasking and organization
- Reporting and documentation
Timeline
Business Analyst
The Elevance Health Companies, Inc
08.2018 - Current
Claim Representative III
The Anthem Companies, Inc
02.2015 - 08.2018
Claims Representative Associate II
The Wellpoint Companies, Inc
02.2012 - 11.2015
Customer Service Representative Member Relations
Wellpoint Companies Inc
10.2010 - 02.2012
Customer Service Representative Provider Relations
National Government Services, Inc
11.2007 - 10.2010
No Degree - Criminal Justice
Northern Kentucky University
No Degree - Criminal Justice
University of Cincinnati Clermont College
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