Stefanie Novo
Mount Dora,FL
Summary
Detail-oriented Stop Loss Claims Examiner with 10 years of experience. Responsible for performing detailed investigations and researching stop loss claim issues. Handles over on average 170+ claims per month and provides exceptional customer service to policyholders. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking and passionate job seeker with strong organizational skills. Ready to help team achieve company goals. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
26
26
years of professional experience
Work History
Senior Stop Loss Claims Examiner
Symetra Life Insurance Company
11.2014 - Current
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
- Served as mentor to junior examiners, sharing expertise and providing guidance on best practices within field of stop loss claims examination.
- Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
- Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.
Miami Office Manager
Symetra Life Insurance Company
10.1999 - 04.2022
- Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records.
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Maintained computer and physical filing systems.
- Developed and maintained successful relationships with vendors, suppliers and contractors.
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
- Conducted regular inventory assessments of office supplies, ordering necessary items proactively to prevent stock shortages.
- Managed office operations while scheduling appointments for department managers.
- Coordinated office events and meetings, ensuring timely execution and optimal scheduling for all participants.
- Served as a liaison between upper management and staff members, facilitating open channels of communication to address concerns or issues promptly.
- Managed compliance to keep organization operating within legal and regulatory guidelines.
- Oversaw facility maintenance requests, coordinating with building management to address repairs or improvements efficiently.
- Developed comprehensive policy manuals outlining procedures and guidelines, contributing to a well-organized workplace culture.
- Reported to senior management on organizational performance and progress toward goals.
- Improved safety procedures to promote employee well-being and safety and protect company from potential liability.
Stop Loss Claim Admin. (Benefits Coordinator)
Symetra Life Insurance Company
04.2004 - 11.2014
- Increased accuracy in claims data entry, ensuring proper documentation for future reference and audits.
- Managed a high volume of daily claims, consistently meeting deadlines without compromising attention to detail or accuracy.
- Gathered and organized materials to support operations.
- Enhanced customer satisfaction by responding promptly to inquiries and addressing concerns professionally.
- Tracked records, filed documents and maintained communication between clients to manage office activities.
- Contributed to business growth by identifying opportunities for process improvement and recommending actionable solutions.
Stop Loss Policy Administrator Manager
Symetra Life Insurance Compnay
10.1998 - 04.2004
- Oversee the Stop Loss Policy Administration team consisting of five (5) to 10 members.
- Conducted detailed policy analysis to identify areas for improvement and recommend necessary adjustments.
- Managed policy documentation, ensuring accurate record-keeping.
- Maintained up-to-date knowledge on relevant laws and regulations affecting company's operations, ensuring consistent compliance with industry standards.
- Provided support during annual budgeting process by evaluating costs related to policy development and administration activities.
- Participated in audits of various departmental policies, ensuring adherence to organizational standards and regulations.
- Delivered comprehensive training sessions to staff members on new and updated policies, increasing overall compliance rates.
- Developed and maintained strong relationships with internal departments and external partners, ensuring effective collaboration on policy-related initiatives.
- Checked documentation for accuracy and validity on updated systems.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
Education
No Degree - Business Administration And Management
Miami Dade College
Miami, FLSkills
- Stop Loss Claims Processing
- Verbal Communication
- Microsoft Office Suite
- Claims Evaluation
- Decision-Making
- Customer service and support
- Team Leadership
- Coverage Determination
- Insurance policy coverage knowledge
- Healthcare Common Procedures Coding System (HCPCS)
- Team Collaboration
- Coaching and Mentoring
- Data Verification
Timeline
Senior Stop Loss Claims Examiner
Symetra Life Insurance Company
11.2014 - Current
Stop Loss Claim Admin. (Benefits Coordinator)
Symetra Life Insurance Company
04.2004 - 11.2014
Miami Office Manager
Symetra Life Insurance Company
10.1999 - 04.2022
Stop Loss Policy Administrator Manager
Symetra Life Insurance Compnay
10.1998 - 04.2004
No Degree - Business Administration And Management
Miami Dade College
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