SOLESE UBURU
St. Louis,MO
Summary
Experienced with evaluating insurance claims to ensure compliance with policies and regulations. Utilizes strong analytical skills to identify discrepancies and facilitate accurate resolutions. Track record of maintaining detailed records and providing exceptional customer service.
Overview
12
12
years of professional experience
Work History
Claims Analyst
Centene Corporation
07.2022 - 10.2022
- Review and process healthcare claims
- Ensure that the claims are accurate
- Access claims to determine if they fall under the scope of the insurance policy and if the claimant is eligible for benefits
- Prepare report and communicate findings to management, highlighting trends, issues, and potential areas for improvement and claims processing
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
Bus operator
Metro Transit
08.2024 - Current
- Drive van to transport passengers over varying route to local or distant point according to a time schedule
- Inspector van before every trip
- Answer questions regarding service, fair, etc.
- Assisted passengers with disabilities, ensuring their safe boarding, travel, and disembarking from the bus.
Associate Clinical Administrative Coordinator
United Healthcare (Optum)
07.2018 - 02.2025
- Identifying specific member and provider demographic information
- Initiating and following up on request for medical records and responses on behalf of clinicians
- Preparing quality of care cases of hand off to clinical reviewers (Nurses, MDs)
- Managing and maintaining quality and productivity metrics
- Scheduling House calls visits
Temporary Service
Ultimate Staffing
09.2013 - 12.2017
- Magellan Health
- Customer Service Associate
- Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers
- Thoroughly documents customers comments/ information and forwards required information to the appropriate staff
- Inform providers and members on Magellan’s appeal Process
- Comprehensively assembled and enter patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs
- Identifies and responds to Crisis calls and continues assistance with the Clinician until the call is resolved
Education
Associate of Applied Science - Business Administration
Missouri College
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University of Phoenix
St Louis, MO03.2013
Masters - Marketing
Missouri College
St. Louis, MO01.2012
Bachelor of Arts - Human Resource Management
Missouri College
09.2010
Skills
- Critical thinking and problem solving
- Teamwork and collaboration
- Professionalism and strong work ethic
- Oral and written communications skills
- Leadership
- Claims analysis
- Interpersonal and written communication
Timeline
Bus operator
Metro Transit
08.2024 - Current
Claims Analyst
Centene Corporation
07.2022 - 10.2022
Associate Clinical Administrative Coordinator
United Healthcare (Optum)
07.2018 - 02.2025
Temporary Service
Ultimate Staffing
09.2013 - 12.2017
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University of Phoenix
Masters - Marketing
Missouri College
Bachelor of Arts - Human Resource Management
Missouri College
Associate of Applied Science - Business Administration
Missouri College
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