Tina Luke
Brandon,FL
Summary
Dynamic Claims Analyst with extensive experience at Anthem, recognized for enhancing customer satisfaction and processing accuracy. Proficient in advanced Excel and analytical thinking, I successfully recovered overpayments and improved claim resolution times. Committed to team collaboration and delivering exceptional results in high-pressure environments.
Overview
15
15
years of professional experience
Work History
Customer Grievance Analyst
Convey Health Solutions
10.2024 - 04.2025
- Reviewing and analyzing grievances by explaining the details of the complaints including supporting documentation to understand the nature of the issue
- Conducting thorough investigations to gather information, identify causes, and propose apporopriate resolutions
- Ensuring that all actions and resolutions are in compliance with regulations, policies and guidelines
- Research and review claims in regards to the grievance being filed
Claims Analyst
NTT Data
09.2023 - 02.2024
- Recieved and reviewed medical insurance claims submissions
- Access information provided in a claim to verify its accuracy, process and insurance claim payouts
- Familiarity with medical terminalogy, procedure and diagnosis codes
- Ability to calculate figures and coinsurance amounts
- Ability to read and interpret EOB;s
- Managed high volume claims caseloads, prioritizing tasks to ensure timely completion of all claims
- Experience with UB, CMS 1450, and CMS 1500 claims
Claims Quality Auditor
Wipro Health Plan Services
10.2020 - 04.2022
- Reduced claim overpayments with meticulous attention to detail in the review of policy coverages and benefits
- Improved turnaround times for claim resolution by identifying processes and recommending solutions during quality audits
- Boosting productivity by creating clear audit guidelines and checklists for consistent assessment of claim files
- Consistently audited approximately 30 claims per day
- Delivered targeted coaching and guidance to claims ;processors via Webex and Skype, resulting in improved processing accuacy and quality
- Ensured adherence to all applicable laws, regulations, and company policy and remained updated on changes in industry standards and adjusted audition practices accordingly
Claims Analyst
Anthem
07.2014 - 07.2020
- Verified accuracy of claims by assissing eligibilty and processing guidelines, coding, pricing, and authorization processed
- Compiled comprehensive claims documentation, identified system errors, and facilitated the recovery of overpayments through detailed reporting and processing information
- Ensured that all claims are processed in accordance with company policies and industry regulations
- Enhanced customer satisfaction by receiving complex claims issues in a timely manner
- Productivity based environment processing 120-140 claims per day
Internal Support Group Representative/CSR
General Dynamics
06.2010 - 07.2014
- Increased customer satisfaction by addressing and resolving complaints in a timely manner.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Enhanced company reputation by providing exceptional customer service and support.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Greeted customers warmly to set tone of customer experience and provide welcoming and friendly atmosphere.
- Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
- Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
- Learned and followed all organizational policies and procedures to maintain safe and professional working environments.
- Communicated with clients and customers to gather, provide and share updated information on products and services.
Education
No Degree - Business Administration
University of South Florida
Tampa, FLSkills
- Proficient in Microsoft Office
- Analytical thinking
- Advanced Excel proficiency
- Time management
- Team collaboration and leadership
- Documentation and reporting
Timeline
Customer Grievance Analyst
Convey Health Solutions
10.2024 - 04.2025
Claims Analyst
NTT Data
09.2023 - 02.2024
Claims Quality Auditor
Wipro Health Plan Services
10.2020 - 04.2022
Claims Analyst
Anthem
07.2014 - 07.2020
Internal Support Group Representative/CSR
General Dynamics
06.2010 - 07.2014
No Degree - Business Administration
University of South Florida
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