Sue Digmann
Manchester,IA
Summary
I have a history of cultivating strong client relationships. I am organized and dependable and approach challenges with a positive attitude. I am a results-oriented problem solver who thrives on continuous improvement.
Overview
39
39
years of professional experience
Work History
Internal Auditor
F&M Bank
08.2021 - Current
- Conducte risk assessments and implementing effective audit recommendations.
- Collaborate with cross-functional teams to design and execute comprehensive audit plans, ensuring alignment with company objectives.
- Evaluate compliance with regulatory requirements, mitigating potential risks and protecting organizational reputation.
- Communicate clear audit findings, and provide recommendations to enhance procedures or develop staff to prevent repeated findings.
- Assist in the development of company policies and procedures, promoting a strong internal control environment.
- Developed strong working relationships with external auditors, facilitating efficient communication during annual audits.
- Participated in special projects as requested by senior leadership, providing subject matter expertise on internal controls and risk management practices.
- Contributed to a positive work environment by collaborating effectively with colleagues across all levels of the organization.
Bookkeeping / Data Processing
F&M BANK
07.2020 - 08.2021
- Manage incoming cash letters, initiate domestic and international wires, import finances for 7 branches, balance work for the end of day
- Assist clients and branches with questions
- Responsible for researching and documenting ACH, Debit Card, and Check Fraud activity.
Assistant Disability Claim Analyst
PRINCIPAL GROUP AND LIFE DISABILITY
10.2019 - 07.2020
- Investigate and process Short Term Disability claims
- Interview with Employees, Employers, and Physicians to gather details about disability claims
- Determine appropriate benefits based on policy provisions
- Selected for the COVID-19 team to create and develop best practices for handling these specialized claims.
Contract Specialist, Payer Contracting
UNITYPOINT HEALTH
01.2012 - 01.2019
- Resolve issues escalated to the contract team by the central billing offices (for Managed Medicaid, Medicare Advantage, and Commercial payers)
- Created process flows and grids for transitioning new entities to the UPH contracts to share status with clients, multiple internal departments, and leadership.
Audit Coordinator
UNITYPOINT HEALTH
01.2012 - 07.2018
- Medicare, Medicaid, and Commercial third party audits
- Partner with multiple teams to research documentation required to support medical necessity or correct coding.
- Manage appeal deadlines throughout all appeal levels, track open Invoices for Medical Record fees.
Senior Claim Account Representative
PRINCIPAL FINANCIAL GROUP
01.2008 - 01.2012
- Communicate with customers and service team to resolve day-to-day issues (interpret plan provisions, elevated claim issues, PPO network issues, authorization requests outside of the plan)
- Participate in renewals and new case implementations
- Assist with staff development through claim reviews, peer coaching and feedback for performance improvement.
Claim Supervisor
PRINCIPAL FINANCIAL GROUP
01.2004 - 01.2008
- Supervise a team of 12-14 claim examiners
- Identify and coordinate workflow and team performance to meet expectations based on contracts and plan provisions
- Serve as policyholder claim contact and partner with other departments to resolve escalated issues
- Represent claim function in meetings for planning and projects.
Claim Specialist
PRINCIPAL FINANCIAL GROUP
01.2000 - 01.2004
- Research, analyze and resolve complex claim issues on various contracts and provisions
- Traveled with regional sales team, Facilitated claim demonstrations and streamlined implementation process for new clients
- Worked closely with online benefit team to appropriately build requested benefits, and tested claim payments prior to effective date.
Trainer
PRINCIPAL FINANCIAL GROUP
01.1994 - 01.2000
- Facilitate classroom training and ongoing technical training programs for new/existing claim staff, including quality review of claim payments
- Create and maintain training documents.
Assistant Claim Supervisor/Medical Claims Examiner
PRINCIPAL FINANCIAL GROUP
01.1985 - 01.1994
- Made claim decisions based on various contracts/plan provisions
- Made outgoing calls to verify or obtain claim information
- Perform claim reviews, assist with claim questions and involved files (pre-existing investigations, overpayments, etc.)
- Experience with processing Medical, Dental, Short Term Disability, and Flexible Spending claims.
Audit Coordinator
UNITYPOINT HEALTH
- Medicare, Medicaid, and Commercial third party audits
- Manage appeal deadlines throughout all appeal levels, track open Invoices for Medical Record fees, and working with appropriate departments to provide audit activity or research documentation required to support medical necessity or appropriate coding
- Led the search for new software vendor to more easily track audits, meet deadlines for providing records and submitting appeals, and compliance reporting.
Education
Computer Operations -
Kirkwood Community College
Cedar Rapids, IA01.1985
Skills
- Medical and Banking Terminology
- Relationship building
- Follow through to validate resolution
- Prioritizing and problem solving
Computer Competencies
Microsoft Office:
- Word
- Excel
- Power Point
- Outlook
- Visio
Volunteer Experience
- Maquoketa Valley Dollars for Scholars Board Member, 2017-Present
- Maquoketa Valley High School Athletic Boosters, Board Secretary, 2010-2017
Training
- Banking Fraud
- Banking Regulations
- HIPAA privacy
- Medical Terminology
- HIAA and FLMI Life and Health Insurance
Timeline
Internal Auditor
F&M Bank
08.2021 - Current
Bookkeeping / Data Processing
F&M BANK
07.2020 - 08.2021
Assistant Disability Claim Analyst
PRINCIPAL GROUP AND LIFE DISABILITY
10.2019 - 07.2020
Audit Coordinator
UNITYPOINT HEALTH
01.2012 - 07.2018
Contract Specialist, Payer Contracting
UNITYPOINT HEALTH
01.2012 - 01.2019
Senior Claim Account Representative
PRINCIPAL FINANCIAL GROUP
01.2008 - 01.2012
Claim Supervisor
PRINCIPAL FINANCIAL GROUP
01.2004 - 01.2008
Claim Specialist
PRINCIPAL FINANCIAL GROUP
01.2000 - 01.2004
Trainer
PRINCIPAL FINANCIAL GROUP
01.1994 - 01.2000
Assistant Claim Supervisor/Medical Claims Examiner
PRINCIPAL FINANCIAL GROUP
01.1985 - 01.1994
Audit Coordinator
UNITYPOINT HEALTH
Computer Operations -
Kirkwood Community College
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