Susan Nutting
AKRON,OH
Summary
Detail-oriented professional with deep experience in claims processing, appeals, and customer issue resolution. Strong in analyzing documentation, interpreting policy terms, and maintaining quality under pressure. Trusted to support audits, reduce errors, and improve processing consistency.
Overview
39
39
years of professional experience
Work History
Claims Processor
Wipro
Akron, OH
09.2015 - Current
- Processed insurance claims accurately, validating documentation and policy coverage for timely adjudication
- Reviewed claim files against payer guidelines, identifying discrepancies and preventing processing errors
- Investigated claim denials, coordinating with internal teams to resolve missing information and exceptions
- Updated claims systems with status changes, notes, and corrective actions to maintain record accuracy
- Interpreted policy terms and operational procedures to support compliant claim decisions and workflows
- Communicated claim requirements to customers and stakeholders, clarifying documentation and next-step actions
- Mentored junior processors on quality checks, claim validation steps, and workload prioritization
- Improved processing consistency by streamlining routine claim reviews and reinforcing standard operating procedures
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to to meet claims processing deadlines.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Trained new employees on claims processing procedures, contributing to a well-prepared workforce.
- Evaluated accuracy and quality of data entered into agency management system.
- Followed up with customers on unresolved issues.
- Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
- Identified fraudulent claims through thorough investigation and documentation of findings.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Maintained detailed records of all processed claims for easy retrieval during audits or disputes.
- Provided support during internal and external audits, ensuring accurate representation of the company''s claim history.
- Enhanced claim processing efficiency by implementing new software and streamlining procedures.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Bolstered client trust and confidence, providing empathetic and knowledgeable support throughout the claims process.
- Reduced backlog of pending claims, prioritizing tasks effectively and efficiently.
- Improved accuracy in claims evaluation, applying detailed knowledge of policy terms and conditions.
- Increased team productivity by leading training sessions on best practices for claims processing.
- Supported team members in achieving their personal and professional goals, fostering collaborative and a supportive work environment.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Checked documentation for accuracy and validity on updated systems.
- Processed and recorded new policies and claims.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Coordinated with contracting department to resolve payer issues.
- Modified, updated and processed existing policies.
Customer Service Manager
UMR
Canfield, OH
01.2001 - 09.2015
- Led customer service team handling member, provider, and employer inquiries with accurate benefit resolution.
- Resolved complex insurance and claims issues by coordinating with operations and clinical teams.
- Coached representatives on call handling, escalation management, and compliance with service standards.
- Monitored service quality, productivity, and call workflows to improve team consistency.
- Implemented process improvements to reduce repeat contacts and strengthen first-call resolution.
- Trained staff on customer service systems, documentation practices, and policy interpretation.
- Reviewed service trends and staffing needs to support efficient queue management and coverage.
- Built collaborative relationships across departments to accelerate issue resolution and member satisfaction.
- Resolved customer complaints while prioritizing customer satisfaction and loyalty.
- Took ownership of customer issues and followed problems through to resolution.
- Managed a team of customer service representatives, fostering a positive work environment focused on teamwork and collaboration.
- Reduced customer complaints, proactively addressing issues and implementing effective solutions.
- Trained and regularly mentored associates on performance-oriented strategies and customer service techniques.
- Supervised employees and assessed performances to determine training needs and define accurate plans for decreasing process lags.
- Followed through with client requests to resolve problems.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Managed complex customer issues effectively, navigating multiple internal resources to identify and implement the best possible solutions.
- Conducted regular performance evaluations for team members, identifying areas for improvement and creating targeted action plans.
- Developed strong relationships with key clients, ensuring their needs were met consistently and promptly.
- Maintained detailed records of interactions with clients, allowing for easy retrieval when needed during follow-up communications or escalations.
- Collaborated with upper management to improve customer service processes and support structures company-wide.
- Researched and corrected customer concerns to promote company loyalty.
- Assisted with pricing questions, inventory availability and changes to existing order and shipping information.
- Increased team productivity by providing ongoing training and support to customer service representatives.
- Facilitated clear communication between departments, ensuring seamless resolution of customer concerns in a timely manner.
- Enhanced customer satisfaction by streamlining support processes and implementing new strategies.
- Kept accurate records to document customer service actions and discussions.
- Boosted customer retention rates through exceptional problem-solving skills and relationship-building efforts.
- Optimized workflow processes to maximize efficiency while maintaining an unwavering commitment to client satisfaction.
- Analyzed customer feedback data to identify trends and areas for improvement, driving continuous enhancement of services provided.
- Implemented quality control measures to maintain high standards of service across all touchpoints within the organization.
- Created and reviewed invoices to confirm accuracy.
- Developed new scripts and guidelines for team members, resulting in more consistent messaging and better overall communication with customers.
- Improved response times for customer inquiries with efficient ticketing system management and prioritization techniques.
- Collaborated with sales teams to develop tailored solutions for prospective clients, resulting in increased revenue generation opportunities.
- Implemented a comprehensive feedback system to enhance service quality.
- Improved service delivery consistency by monitoring and adjusting workflows.
- Enhanced team productivity with the introduction of flexible working arrangements.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Established team priorities, maintained schedules and monitored performance.
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
- Defined clear targets and objectives and communicated to other team members.
- Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
- Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
- Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills.
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
Appeals Specialist
HealthPlan Services
Canfield, OH
01.1991 - 01.2001
- Interpreted plan benefits to resolve complex appeal issues accurately.
- Reviewed member appeals for medical necessity, coverage determinations, and plan policy compliance.
- Validated supporting records, physician notes, and eligibility data before case adjudication.
- Coordinated case documentation across claims, utilization review, and customer service teams.
- Drafted clear appeal letters with compliant rationale and resolution details.
- Trained staff on appeal workflows, documentation standards, and turnaround expectations.
- Monitored regulatory requirements to ensure consistent appeals processing and audit readiness.
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
- Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
- Maintained high levels of accuracy in all written correspondence, ensuring clear communication with relevant stakeholders during the appeals process.
- Acted as a departmental resource on appeals matters.
- Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
- Educated clients on their rights and responsibilities throughout the appeals process, ensuring a clear understanding of expectations and potential outcomes.
- Regularly received commendations from supervisors for demonstrating exceptional commitment to customer service and dedication to client satisfaction throughout the appeals process.
- Assisted in refining company policies surrounding claims denials management by sharing insights gleaned from experiences working on various types of appeals cases.
- Increased customer satisfaction ratings through timely follow-up on appeal status inquiries, providing accurate information and addressing concerns promptly.
- Demonstrated exceptional attention to detail when evaluating medical records in order to identify discrepancies or inconsistencies that could impact an appeal''s outcome positively or negatively.
- Optimized internal communication channels between departments to ensure seamless coordination on complex appeals cases requiring input from multiple sources.
- Improved the appeals success rate by researching legal precedents and staying up-to-date with current industry regulations and guidelines.
- Played a key role in multiple successful audit reviews by maintaining meticulous records and upholding strict compliance standards in all appeal-related activities.
- Contributed to team growth by actively participating in peer mentoring initiatives designed to improve overall departmental skill sets and knowledge.
- Managed multiple priorities simultaneously while maintaining attention to detail and meeting deadlines under pressure.
- Maintained strict confidentiality of patient information in accordance with HIPAA regulations.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Verified client information by analyzing existing evidence on file.
- Calculated adjustments, premiums and refunds.
- Maintained confidentiality of patient finances, records, and health statuses.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Checked documentation for accuracy and validity on updated systems.
- Processed and recorded new policies and claims.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Coordinated with contracting department to resolve payer issues.
Eligibility Specialist
Dun & Bradstreet Planned Services
Tampa, FL
01.1988 - 01.1991
- Interpreted policy requirements to resolve complex eligibility discrepancies and coverage questions.
- Verified eligibility data for benefit enrollments, ensuring accurate records across member accounts.
- Reviewed supporting documentation to confirm participant status and maintain compliance standards.
- Updated enrollment and demographic information in administrative systems with consistent accuracy.
Education
High School Diploma -
Warren G Harding High School
Warren, OHSkills
- Claims
- Claims review
- Policy interpretation
- Claims management
- Accuracy and precision
- Attention to detail
- Critical evaluation
- Work prioritization
- Work organization
- Time management
- Business correspondence
- Decision-making
- Claims assessment
- Teamwork and collaboration
- Business writing
- Reliability
Timeline
Claims Processor
Wipro
09.2015 - Current
Customer Service Manager
UMR
01.2001 - 09.2015
Appeals Specialist
HealthPlan Services
01.1991 - 01.2001
Eligibility Specialist
Dun & Bradstreet Planned Services
01.1988 - 01.1991
High School Diploma -
Warren G Harding High School