Stephanie Barker
Coeburn,VA
Summary
Organized, hard-working employee with excellent time management skills seeking a position as a Claims Analyst. Experienced and self-motivated with valuable analyst experience and passion for management. Results-oriented with a proven track record of working collaboratively with a team to achieve goals. Interested in leveraging experience in both analytical and customer service roles along with skills in supervising operations. Accomplished Case Manager adept at handling high caseloads without sacrificing quality of care. Operates exceptionally well in high-pressure environments. Recommends best resources and courses of action to benefit patient needs and return each to optimal quality of life.
Overview
5
5
years of professional experience
Work History
Case Manager
Moms In Motion
01.2025 - Current
- Coordinated client assessments and developed individualized service plans.
- Facilitated communication between clients, families, and service providers.
- Monitored client progress and adjusted care plans as needed.
- Conducted regular case reviews to ensure compliance with regulations.
- Collaborated with community resources to enhance client services.
- Documented case notes and maintained accurate records in database systems.
- Educated clients on available resources and support networks.
- Monitored client progress through regular follow-up contacts.
- Assessed clients' needs, developed service plans and monitored progress towards goals.
- Counseled clients on available resources within the community that could help meet their needs.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Developed trusting relationships with social services, health care providers and governmental agencies.
- Participated in regular team meetings and in-house training sessions to boost group effectiveness.
- Adhered to ethical principles and standards to protect clients' confidential information.
- Compiled reports on cases and submitted them to supervisors as required.
- Assisted individuals with eligibility for available benefits.
- Reviewed treatment plans against individual goals and healthcare standards.
- Supported family members by providing information on local support groups.
Claims Analyst II
2-10 Homebuyer’s Warranty
03.2024 - 01.2025
- Answer inbound calls from Service Providers and/or Homeowners seeking assistance with their claims.
- Make outbound calls to Service Providers and Suppliers for updates on parts and equipment and/or to obtain additional information needed to proceed with the claim process.
- Notate all claims discussed on the call when assisting a caller.
- Create and Send Follow-up Requests to other departments or the Service Provider.
- Achieve and maintain performance standards (Attendance, AHT, Availability, Quality, etc)
- Accepting offers on Parts/Equipment
- Obtaining Diagnosis from Service Provider
- Reviewing Service Agreement for Coverage Eligibility
- Determining Coverage based on diagnosis provided by Service Provider
- Providing Authorizations to Service Provider to proceed with repair/replacement of a system or appliance.
- Determining and explain non-covered costs and/or denials.
- Educating customers on system, components, their function and how coverage is applied
- Diffusing escalated claim situations
- Analyzed claims data to identify trends and patterns in customer requests.
- Reviewed documentation to ensure compliance with company policies and procedures.
- Communicated with homeowners and contractors to gather necessary information for claims.
- Investigated claim disputes by coordinating with relevant departments and stakeholders.
- Processed claims efficiently, ensuring timely resolution for customers' concerns.
- Maintained accurate records of claims activities in the company's management system.
- Collaborated with team members to refine processes and enhance service delivery.
- Assisted in training new hires on claims procedures and best practices for efficiency.
- Conducted investigations to gather evidence in support of claims resolution.
- Verified documents to ensure accuracy of information provided by customers.
- Investigated claim and settlement deals and reviewed coverage determinations.
- Reviewed coverage determinations, investigated and evaluated claims and negotiated settlements.
- Maintained accurate records of all claim activities in accordance with company policies.
- Assessed medical records for coverage eligibility and benefit accuracy.
- Assessed processing reports each day to effectively submit claims.
- Followed all company procedures to keep data confidential.
- Prepared detailed reports on claim status, payment history, and other relevant information.
- Participated in meetings with internal departments or external vendors as necessary to discuss disputed claims or other related matters.
- Managed escalated cases involving high-value claims or multiple parties involved.
- Reviewed appeals filed by claimants who were dissatisfied with initial decisions made concerning their cases.
- Gathered proper documentation and data to prepare claims for submission.
- Analyzed claim data to identify trends and recommend process improvements.
- Ensured compliance with federal and state regulations governing insurance industry operations.
- Researched applicable laws and regulations related to insurance policies and procedures.
- Implemented process improvements after noticing several areas in underachieving department areas.
- Evaluated requests for additional benefits or changes in existing coverage levels.
- Provided guidance to customers regarding their rights and obligations under policy terms.
- Developed strategies for resolving complex claims issues.
- Investigated and analyzed requirements to improve timeliness of reports to customers.
- Interpreted contracts to determine liability exposure in the event of a dispute or lawsuit.
- Advised customers on filing requirements, documentation needed, and other matters pertaining to their claims.
- Prepared recommendations for management regarding potential liability exposures associated with certain types of claims.
- Compared data from surveillance footage to data on medical reports.
- Synthesized data into comprehensive quarterly written reports for management.
- Negotiated settlements with claimants and attorneys to resolve claims efficiently and fairly.
- Collaborated with legal team to resolve any disputes arising from denied or delayed payments.
- Maintained confidentiality of claimant information in accordance with privacy laws and regulations.
- Analyzed claims data to determine coverage and liability, ensuring accurate decision-making.
- Documented all claims activities clearly and concisely in the claims management system.
- Supported policyholders through the claims process, providing exceptional customer service.
- Investigated complex claims by gathering information from various sources to assess validity.
- Utilized claims processing software to update and maintain accurate claim files.
- Conducted training sessions for new hires on claims processing and company protocols.
- Collaborated with underwriting teams to suggest policy adjustments based on claims trends.
- Coordinated with healthcare providers to verify services rendered and resolve billing discrepancies.
- Identified and addressed suspicious claims through detailed analysis to prevent fraud.
- Participated in claims audit processes to ensure compliance with internal and external standards.
- Monitored ongoing claims to adjust reserves as necessary and ensure accurate financial reporting.
- Assisted in the development and implementation of claims procedures to improve efficiency.
- Managed workload effectively to ensure timely processing of claims within designated deadlines.
- Coordinated with external adjusters and experts for claims requiring specialized evaluation.
- Input claim information and payments into company database.
- Analyzed information gathered by investigations and reported findings and recommendations.
- Contacted banks to acquire credit information.
- Discussed current cases and issues in claim committee meetings.
- Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.
- Reduced loss ratios through fair and prompt processing of claims.
- Conducted secondary evaluations of original investigations documentation and reports to facilitate smooth resolutions.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
- Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
- Investigated properties, classified damages and created estimates outlining repair costs.
- Coordinated emergency repair, cleaning companies and contractors to optimize customer claim handling.
- Traveled to customer sites to evaluate fallen trees, leaking roofs and other issues to create accurate cost estimations.
- Coordinated with law enforcement and testified at criminal proceedings.
- Investigated fraudulent claims by gathering evidence from various sources.
- Reviewed customer claims, identified discrepancies and determined appropriate course of action.
Claims Analyst Supervisor
Advanced Call Center Technologies
01.2021 - 03.2024
- Ensuring claims processes move to ensure a timely resolution.
- Analyzing claims, researching, investigating, processing, and adjusting the claims as needed.
- Researching accounts activity to judge the level of risk and type.
- Supervises a team of clerical and administrative support clerks in a banking operations group.
- Schedules and monitors production activities to ensure all production goals are achieved and maintained at an average of 100% per month.
- Oversee the training of associates (currently 40+ to date).
- Researching and resolving any escalated processing issues, along with conducting quality audits to verify agent errors and mentor accordingly to increase customer and client satisfaction.
Verification Specialist
Lowers Risk Group
11.2021 - 03.2022
- Managed inbound and outbound communication regarding background check clearance and verification for education, employment, references, and licensing purposes.
- Maintained records of all communication to ensure all verifications and follow-up were timely.
- Provided services to thousands of businesses internationally on a specialist team that reviewed client specific instructions to meet company standards. Ensured the confidentiality of all sensitive information.
Fraud Claims Analyst
Advanced Call Center Technologies
10.2020 - 01.2021
- Served as a successful fraud analyst, promoting to operations supervisor, and achieving success through my skills within a three-month time frame.
- Provided secondary analysis on escalated accounts
- Processing back office clerical claims by verifying and updating the information about submitted claims and reviewing the work process required to determine reimbursement.
- Investigate the credit card processing, monitor for chargebacks, flag suspicious refunds, and any suspicious / potential fraud merchant on accounts.
- Utilize research and analytical tools to make sound funding decisions within a required timeframe as determined by management.
Education
Medical Billing and Coding
Purdue Global
09-2025
High School Diploma -
Eastside High School
Coeburn, VA01.2012
Skills
- Customer service
- Leadership
- Excel
- Microsoft Office
- Communication
- Problem solving
- Fast learner
- Analytical claims processing
- Medical billing
- Data analysis
- Claims processing
- Effective communication
- Service coordination
- Relationship building
- Quality assurance controls
- Conflict resolution
- Financial support
- Indirect patient care
- Resource identification
- Performance tracking
- Medical coding
Timeline
Case Manager
Moms In Motion
01.2025 - Current
Claims Analyst II
2-10 Homebuyer’s Warranty
03.2024 - 01.2025
Verification Specialist
Lowers Risk Group
11.2021 - 03.2022
Claims Analyst Supervisor
Advanced Call Center Technologies
01.2021 - 03.2024
Fraud Claims Analyst
Advanced Call Center Technologies
10.2020 - 01.2021
Medical Billing and Coding
Purdue Global
High School Diploma -
Eastside High School
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