Tiffany T. Fleig
Rome,Georgia
Summary
Dedicated health insurance claims/benefits analyst with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
14
14
years of professional experience
Work History
Business Analyst II
Elevance Health
04.2024 - Current
- Collaborate with healthcare providers to identify and resolve claim overpayments.
- Perform gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
- Analyze large data sets to uncover patterns and trends.
- Analyze data to identify root causes of problems and recommend corrective actions.
- Actively participate in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Improve business processes by analyzing current practices and recommending optimization strategies.
- Implement best-practice methodologies that improves overall project delivery timelines while maintaining quality standards.
Benefits Analyst II
Elevance Health
04.2022 - 02.2024
- Maintained avoidance to negative financial, regulatory, and operational impact.
- Performed testing and quality assurance of product developed.
- Research and analysis of RFP proposals, small product enhancements, and product projects.
- Created and maintained issue log on appropriate tool, resolved defects based on knowledge and analysis of system functionality.
- Researched and responded to inquiries from various departments.
- Created groups and membership
- Configured adjudication profiles for claims
- Keyed and tested claims to ensure the correct benefits and payment rates are being applied
Financial Operations Recovery Specialist III
Anthem
03.2021 - 04.2022
- Audited paid claims for overpayments using various techniques including systems-based queries, and specialized reporting.
- Worked with recovery and collection vendors to validate overpayments, validate vendor invoices and provide feedback to modify queries when needed.
- Completed special projects as assigned with minimal supervision.
- Researched voluntary refunds for accuracy.
- Interacted with staff and management from other departments on regular basis to ensure customer satisfaction
- Worked closely with contract managers to identify and correct contractual issues, if applicable
- Handled complex case research and resolution
- Performed collection activities to ensure recovery of overpayments and maintenance of unprocessed cash accounts receivable processes and all other cash applications as required
- Assisted in special projects to find and prevent overpayments and to identify process improvements
- Accurately balanced all accounts
ECOB Specialist II
Anthem
12.2018 - 03.2021
- Utilized internal queries, internal resource tools, initiated delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and identified members who are or should be enrolled in other coverage.
- Aided members in enrolling in Medicare when they are entitled.
- Determined primacy on each case using complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules and comparing them against member/groups Anthem Benefits.
- Updated all of company's membership system components with investigation results for claim coordination.
- Ensured correct forms were provided to assist members enrolling in Medicare.
- Reviewed claim history to identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.
- Identified correct formulas in order to adjudicate impacted claims, using multiple COB Formulas for various product types, pursuant to State and Federal Guidelines
- Analyzed information gathered by investigations to report findings.
Claims Processor/ Adjuster
Insurance Administrative Solutions, LLC
06.2018 - 11.2018
- Processed members claims that were sent in.
- Did extensive benefit research to ensure that correct benefit amounts were being paid out, searched several databases to see if members had additional policies that were forgotten and still eligible for benefit payouts.
- Answered calls and contacted members to advise payout information and explain how their policies work.
- Followed up with customers on unresolved issues.
- Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Calculated adjustments, premiums, and refunds.
- Generated, posted and attached information to claim files.
Claims Representative II
Anthem
06.2014 - 05.2018
- Worked productively in fast-moving work environment to process large volumes of claims.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Calculated adjustments and refunds.
- Checked level and type of coverage and evaluated contracts.
Customer Care Representative
Anthem
07.2013 - 07.2014
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
- Built long-term, loyal customer relations by providing top-notch service and detailed order, account and service information.
- Described product highlights and benefits to help members understand their policies better.
- Logged call information and solutions provided into internal database.
- Helped large volume of members every day with positive attitude and focus on customer satisfaction.
- Responded to member needs through competent customer service and prompt problem-solving.
Data Entry Analyst
Manpower
07.2011 - 09.2012
- Checked documentation for accuracy and validity on updated systems.
- Verified client information by analyzing existing evidence on file.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Modified, updated and processed existing policies.
- Completed data entry tasks with accuracy and efficiency.
- Supported multiple departments with special projects.
Education
High School Diploma -
Jordan Vocational High School
Columbus, GA2007
Skills
- Detail-Oriented
- Critical Thinking
- Microsoft Excel
- Microsoft Outlook
- Financial Analysis
- Analytical Thinking
- Customer Complaint Resolution
- Honest and Ethical
- Client Engagement
- Claims Processing and Adjusting
- WGS
- Spider
- FACETS
- NetworX Pricer
- WPD
- CMA
- JIRA
- Business Objects
- FUSE
- COR
- ACR
- CBAS
- BDS
- CAQH
- Solutions Central
- CCERT
- Access
- CI&W
- MACESS
- WCF
- SharePoint
Timeline
Business Analyst II
Elevance Health
04.2024 - Current
Benefits Analyst II
Elevance Health
04.2022 - 02.2024
Financial Operations Recovery Specialist III
Anthem
03.2021 - 04.2022
ECOB Specialist II
Anthem
12.2018 - 03.2021
Claims Processor/ Adjuster
Insurance Administrative Solutions, LLC
06.2018 - 11.2018
Claims Representative II
Anthem
06.2014 - 05.2018
Customer Care Representative
Anthem
07.2013 - 07.2014
Data Entry Analyst
Manpower
07.2011 - 09.2012
High School Diploma -
Jordan Vocational High School