Experienced insurance professional with nine years of experience working in both the health and automotive industries, determining liabilities and coding benefits. Detail-oriented, observant, and knowledgeable with excellent interpersonal and documentation skills.
Hi, I’m
Stephanie Dressler
McAllen,TX
Summary
Overview
10
years of professional experience
Work History
Farmers Insurance CompanyOklahoma City, OK
Regional Claims Adjuster
04.2022 - Current
Job overview
- Investigated insurance claims, reviewed coverage and liability, prepared reports and recommended payment or denial of claims.
- Researched relevant laws, regulations, legal decisions and precedents to determine appropriate course of action.
- Interpreted policy language to determine coverage for insureds under various lines of business.
- Reviewed medical records, police reports and other documents related to claim investigations.
- Conducted interviews with claimants and witnesses to obtain additional information about the claim.
- Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
- Maintained accurate documentation of all claim activity within designated system.
- Utilized computer systems such as Microsoft Office Suite and specialized software programs used by the company.
- Adhered strictly to departmental guidelines; ensured that all activities were compliant with applicable state laws.
- Ensured timely follow-up on all open matters; kept stakeholders informed regarding status updates.
- Worked collaboratively with team members across multiple departments; identified areas where processes could be improved.
Blue Cross and Blue Shield of Kansas CityKansas City, MO
Operations Applications Specialist/ Plan to Plan Specialist (Benefits Related-Plan to Plan Specialist Promoted to OAS)
07.2019 - 04.2022
Job overview
- Worked with sales, group auditors, and Human Resources Directors to resolve issues with coded benefits as well as obtain a better understanding of what benefits a company was looking to change
- Coded and loaded medical and dental benefits for large employer groups in Facets to ensure claims were paid correctly
- Reviewed members' deductibles, max out-of-pocket amounts, accumulators, and benefits when issues arose with claim payments to ensure that coding was accurate and complete, and made corrections as needed
- Created summary of benefits coverage documents for members after coding in Facets was complete
- Created internal standard operating procedure documents
- Worked on large-scale projects involving removing outdated coding in Facets
Blue Sprig PediatricsHarlingen, TX
Operations Applications Specialist/ Plan to Plan Specialist
03.2019 - 06.2019
Job overview
- Responsible for interviewing, hiring, and terminating employees
- Provided safety training
- Processed benefits paperwork and recorded safety violations
- Provided tours to prospective families wishing to enroll their children in an applied behavioral therapy program for autism
- Verified prospective client's insurance, followed up on prior authorization requests, and determined the reason for delays or rejection in payment so that they could be resolved
- Worked with contractors to resolve issues with the building to ensure health and safety standards were met
- Reviewed options for benefit payouts for employees exiting the company
- Reviewed benefits paperwork with new employees and
- Performed exit interviews
- Supervised day-to-day workflow of employees in order to maximize productivity and maintain quality standards.
Plymouth VillageRedlands, CA
Human Resources Assistant
10.2017 - 02.2019
Job overview
- Tracked workman’s comp incidents, vaccines, DMV pull requests, and training to maintain compliance with state and federal regulations
- Audited numerous files and worked with employees to ensure compliance with all federal and state laws.
- Assisted in recruiting and hiring processes by conducting phone screens, scheduling interviews, and completing reference checks.
- Maintained accurate records of employee information such as wages, performance reviews, benefits, leaves of absence.
- Organized and conducted new hire orientation sessions to introduce policies and procedures to employees.
- Conducted exit interviews with departing employees to gather feedback about their experience with the organization.
- Managed employee relations issues including grievances, complaints, and disputes as needed.
- Responded to inquiries from current or prospective employees regarding human resources policies or procedures.
- Processed paperwork associated with personnel transactions such as promotions or terminations.
- Monitored timekeeping records for accuracy and completeness.
- Reviewed resumes submitted by applicants for open positions.
- Assisted with planning, organizing and coordinating company events.
- Guided new hires through orientation and onboarding and explained documentation requirements to facilitate HR process.
- Assisted candidates with application processes by answering questions about application, performing background checks, providing I-9 forms and handling drug screening paperwork.
- Prepared and set up new employee orientations.
Blue Cross Blue Shield of Kansas CityKansas City, MO
Coordination of Benefits Specialist
06.2016 - 06.2017
Job overview
- Assisted claims examiners and clinicians via research and subject matter expertise on possible other party liability, other payor liability, and primacy
- Tracked weekly/monthly reports; maintained information database to ensure rapid and effective claim processing
- Ensured accuracy of member information
- Coordinated among departments and third parties for effective claims resolution
- Maintained written and oral communication with members and stakeholders
- Eliminated unnecessary company spending/fines.
Blue Cross Blue Shield of Kansas CityKansas City, MO
Customer Service Representative
04.2014 - 06.2016
Job overview
- Communicated closely with customers and providers to explain highly complex benefit and claim information
- Corresponded with members and providers
- Provided technical assistance for web portal
- Performed detailed research/analysis on claims, allowable rates, check status, etc.; provided expertise to members on appeals, and processes
- Adjudicated claims and escalated as necessary
- Resolved problems for members and providers
- Earned two promotions within 1.5 years
- Received High Performance Bonus
- Responsible for daily access to and protection of sensitive/confidential information.
Education
Regent UniversityVirginia Beach, VA
Master of Science from Clinical Psychology
05.2024
University Overview
Old Dominion University
Bachelor of Science, Business Administration
University Overview
Skills
- Coordination of Benefits
- Employee Onboarding, Orientation, and Exit Interviews
- Benefit Fairs & Management
- Creating Summaries of Benefits Coverage and Facets Coding
- Tracking Professional Licensure, Leave of Absence Requests, and Safety Incidents to Ensure Compliance Standards Were Maintained
- Reviewing Complex Claims and Contract Language as Related to Health and Auto Insurance
- Resolving Issues with Payment of Escalated Health Insurance Claims
- Health Insurance Claims Adjudication
- Claims Investigation and Liability Determination
- Advanced Computer Skills
- Regulatory Compliance
- Strong oral and written communication skills
References
References
References available upon request.Timeline
Regional Claims Adjuster
Farmers Insurance Company
04.2022 - Current
Operations Applications Specialist/ Plan to Plan Specialist (Benefits Related-Plan to Plan Specialist Promoted to OAS)
Blue Cross and Blue Shield of Kansas City
07.2019 - 04.2022
Operations Applications Specialist/ Plan to Plan Specialist
Blue Sprig Pediatrics
03.2019 - 06.2019
Human Resources Assistant
Plymouth Village
10.2017 - 02.2019
Coordination of Benefits Specialist
Blue Cross Blue Shield of Kansas City
06.2016 - 06.2017
Customer Service Representative
Blue Cross Blue Shield of Kansas City
04.2014 - 06.2016
Regent University
Master of Science from Clinical Psychology
Old Dominion University
Bachelor of Science, Business Administration
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