Sonia Brattlie Miller
Middleton,WI
Summary
Results-driven Senior Claims Professional with extensive experience in leading complex claims investigations and ensuring compliance with regulatory standards. Proven ability to mentor junior staff and enhance operational efficiency through strategic analysis.
Overview
39
39
years of professional experience
1
1
Certification
Work History
Senior Claims Professional
TruStage
Madison, WI
09.1998 - Current
- Led complex claims investigations to ensure timely and accurate resolutions.
- Mentored junior claims staff on best practices and regulatory compliance.
- Analyzed claim data to identify trends, improving operational efficiency and accuracy.
- Reviewed policy changes and updates, ensuring alignment with industry standards and regulations.
- Conducted thorough investigations for accurate liability determination, leading to fair claim resolutions.
- Managed a caseload of complex claims, ensuring timely settlements and maintaining client satisfaction.
- Streamlined claims processing by implementing efficient workflow procedures and prioritizing high-impact cases.
- Boosted customer satisfaction ratings by providing prompt responses to inquiries and resolving issues in a timely manner.
- Mitigated potential losses by identifying fraudulent claims and coordinating with the fraud investigation unit.
Customer Service Representative /Health Insurance Claims Adjudicator
Rural Mutual Insurance
Madison, WI
01.1987 - 09.1998
- Resolved customer inquiries and complaints efficiently, enhancing overall satisfaction.
- Provided product knowledge and support to clients, ensuring clarity on policy details and options.
- Mentored junior representatives, fostering skill development and promoting a collaborative team environment.
- Implemented process improvements that reduced response times, driving higher operational efficiency in service delivery.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Trained new Customer Service Representatives on company policies, procedures, and best practices.
- Investigated and resolved customer inquiries and complaints quickly.
- Delivered prompt service to prioritize customer needs.
- Evaluated health insurance claims for accuracy and compliance with policy guidelines.
- Reviewed medical documentation to determine claim validity and appropriate reimbursement levels.
- Collaborated with healthcare providers to clarify information regarding submitted claims.
- Mentored junior adjudicators on best practices and claims processing procedures.
- Promoted positive relationships with healthcare providers through consistent communication, professional conduct, and timely payment resolutions.
Education
High School Diploma -
Barneveld High School
Barneveld Wi 05-1983
Skills
- Claims management expertise
- Insurance policy sales
- Legal compliance
- Policy interpretation
- Investigative tools
- Regulatory awareness
- Claims investigation
- Claims analysis
- Teamwork
- Customer service
- Problem-solving
- Time management
- Multitasking Abilities
- Critical thinking
- Verbal and written communication
Certification
AHIP - DIA Designation
LOMA - Foundations of Customer Service
Timeline
Senior Claims Professional
TruStage
09.1998 - Current
Customer Service Representative /Health Insurance Claims Adjudicator
Rural Mutual Insurance
01.1987 - 09.1998
High School Diploma -
Barneveld High School