Tia Gorden
Duluth,MN
Summary
Experienced professional with 9+ years of progressive growth at United Healthcare, specializing in claims processing and customer service. Started as a Claims Processor for Behavioral Health and transitioned to a Benefit Advocate role, achieving Elite Advocate status. Delivered exceptional support to members regarding claims inquiries and healthcare needs. In 2020, accepted the position as a Claims Business Process Analyst Senior under Government Operations Appeals & Grievances & HRA, successfully analyzing and resolving complex issues related to Complaints to Medicare Cases (CTMs). Also gained valuable experience in project management, completing multiple projects. Currently serving as a Claims Business Process Consultant under Government Operations Benefit Configuration, leveraging extensive background at UHC. Collaborates with various departments to facilitate smooth Claims Migration for new and existing Health Plans.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Claims Business Process Consultant Senior
UnitedHealth Group
12.2022 - Current
- Represent, track, and support all claims readiness tasks associated with migration impacting Claims Operations.
- Collaborate with department team leads and SMEs to ensure all issues or concerns are accounted for each assigned task.
- Analyze Post-Go Live reporting for FFS Claims trends.
Claims Business Process Analyst Senior
UnitedHealth Group
12.2020 - 12.2022
- Use pertinent data and facts to identify and solve range of problems within area of expertise.
- Investigate non-standard requests and problems, with some assistance from others.
- Review complaints to analyze information and determine root cause to remediate.
- Create Claims Projects to identify trends and provide resolutions.
- Prioritize and organize own work to meet deadlines.
Elite Advocate
UnitedHealth Group
04.2017 - 12.2020
- Advocate for members to achieve first call resolution.
- Place outbound calls to providers, members, and internal reps as needed to resolve issues.
- Maintain strong knowledge of internal processes and group-specific processes.
- Ensure plan information is delivered accurately to members.
- Educate members on plan features and self-service options.
- Create innovative solutions to resolve highly escalated and complex member concerns.
- Worked effectively with fellow team members to coordinate effective solutions to any question or concern.
Claims Representative
Optum Operations
07.2013 - 04.2017
- Work independently to resolve, research, investigate, adjust, and process UBH claim issues from providers and claim representatives.
- Utilize multiple systems to research issues and complete claim processing (UNET, COSMOS, CPW, PCOMM, CSP Facets).
- Analyze and identify trends and provide reports.
- Consistently meet production and quality standards.
Education
A.S. - Medical Coding and Billing
Hibbing Community College
Hibbing, MN07.2012
Skills
- Fast Learner
- Time Management
- Problem-Solving
- Medical Coding
- Innovation
- Collaborator
- Customer Service
- Research Analysis
- Project Management
- Claims Knowledge
- Microsoft Excel
- ServiceNow
- M&R Claims Platform experience
- Visio Experience
- Six Sigma
Certification
Six Sigma Green Belt
Green Belt Certification
A Green Belt project is intended to demonstrate proficiency in applying a variety of process improvement tools to address a real-world business problem. I had the honor to complete a Green Belt Project surrounding the Business Partner Connections Gallery (BPCG) Tool that is owned by Mary Higgins team. The idea is to enhance the BPCG tool to include the different teams listed under MEADO and build out each team's and individual's roles and responsibilities. The purpose of this idea is to provide visibility into each team's roles and responsibilities and to more accurately identify the appropriate contacts and resources the first time. I was awarded on November 22nd 2024 the Six Sigma Green Belt Certified Certificate by Steve Hardgrave. I am excited to utilize the skills i gained with obtaining this certificate in 2025 and applying it to the Value Based Care Model.
Timeline
Claims Business Process Consultant Senior
UnitedHealth Group
12.2022 - Current
Claims Business Process Analyst Senior
UnitedHealth Group
12.2020 - 12.2022
Elite Advocate
UnitedHealth Group
04.2017 - 12.2020
Claims Representative
Optum Operations
07.2013 - 04.2017
A.S. - Medical Coding and Billing
Hibbing Community College
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