Summary
Work History
Education
Skills
Timeline
Generic

Sean Lalik

Columbus

Summary

Detail-oriented Program Integrity Analyst with a proven track record in data analysis, documentation, and reporting. Expertise in identifying trends and fostering team collaboration to enhance operational efficiency. Dependable team player with a strong work ethic and the ability to quickly adapt to new and challenging workplace situations. Proficient in Microsoft Word and Excel. Excellent written and verbal communication skills,

Work History

Program Integrity Analyst II

CoventBridge
2015 - 2026
  • Conducted comprehensive research to identify market opportunities and risks.
  • Analyzed data trends to support strategic decision-making processes.
  • Developed reports summarizing findings for senior management review.
  • Conducted proactive and reactive analysis of Medicare claims data to pinpoint fraudulent billing practices.
  • Cultivated a team environment that facilitated workload knowledge.
  • Conducted interviews with providers and beneficiaries.
  • Assisted with mentoring new employees.

Medicare Appeals Analyst

Q2A Maximus
2013 - 2014
  • Analyzed appeals and provided detailed recommendations for case resolution.
  • Facilitated communication between stakeholders to streamline the appeals process.

EDI Operations Associate

Palmetto GBA (Palmetto GBA Assumed Contract From Nationwide Insurance in 2002)
1993 - 2013
  • Analyzed ANSI test data from providers, software vendors, clearing houses, and billing services to ensure compliance with industry regulations.
  • Developed training materials for new team members, fostering a collaborative learning.
  • Processed EDI Enrollment Forms.
  • Functioned as a liaison between CMS, the Coordination of Benefits Contractor (COBC).
  • Compiled daily and monthly reports for CMS.
  • Provided offsite and in house training on proprietary software for Medicare providers.

Medicare Claims Examiner

Nationwide Insurance Company
1992 - 1993
  • Analyzed claim documentation for accuracy, identifying discrepancies to enhance processing efficiency.
  • Reviewed and processed claims to ensure compliance with policy guidelines and regulatory requirements.
  • Collaborated with internal teams to resolve complex claims issues, improving customer satisfaction.
  • Assisted in training new team members on claims procedures and company policies for seamless onboarding.

Education

Music Education

The Ohio State University
Columbus, OH

Skills

  • Microsoft Office Suite
  • Analytical thinking
  • MS Excel
  • Time management
  • Team collaboration
  • Attention to detail
  • Documentation management

Timeline

Program Integrity Analyst II

CoventBridge
2015 - 2026

Medicare Appeals Analyst

Q2A Maximus
2013 - 2014

EDI Operations Associate

Palmetto GBA (Palmetto GBA Assumed Contract From Nationwide Insurance in 2002)
1993 - 2013

Medicare Claims Examiner

Nationwide Insurance Company
1992 - 1993

Music Education

The Ohio State University

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Sean Lalik