Tina McClelland
Summary
Dynamic Medical Claims Supervisor with extensive experience at NALC Health Benefit Plan, excelling in claims processing, authorizations and customer service. Proven problem solver with a strong grasp of prior and retro authorization processes and exceptional communication skills. Achieved operational efficiencies while fostering relationships with insurance providers including Medicare, ensuring timely claims resolution and superior service delivery.
Overview
23
23
years of professional experience
Work History
Medical Case Management Supervisor
NALC Health Benefit Plan
06.2002 - 09.2025
- Collected medical documentation to support claims processing and payment.
- Worked with medical records to analyze priorauthorization and retroauthorization requests.
- Requested additional medical information when needed.
- Developed and maintained excellent oral and verbal relationship with other health insurance companies, vendors and providers.
- Worked daily with claims and authorization prior and retro appeals to ensure necessary information was obtained.
- Reviewed accounts for nonpayment to assess and obtain the needed information for payment/approval.
- Worked with secondary insurance companies to obtain missing information to facilitate provider payment.
- Provided daily customer service with insurance companies and health care providers.
Senior Customer Service Manager
NALC Health Benefit Plan
06.2002 - 09.2025
- Updated account information in each customer's record to keep data accurate.
- Enhanced customer satisfaction ratings by resolving technical, on-site and account issues efficiently.
- Responded to customer inquiries and queries to provide thorough and speedy resolutions.
- Addressed on average 75 inbound and outbound customer calls daily.
- Directed team of 35 claims and customer service analysts to enhance across-the-board customer support and facilitate claim payment.
- Answered multi-line phones and used active listening skills to assess client's issues and challenges.
- Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
- Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Managed senior-level personnel working in claims payment and customer service capacities.
Claims Supervisor
NALC Health Benefit Plan
06.2002 - 09.2025
- Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
- Insured HIPAA compliance.
- Gathered sensitive information to update customer profiles and help with appeals process.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Manage up to 125 calls to gather information to initiate claims and prior/retro authorization process.
- Established and checked coding procedures, monitored reports and updated internal files.
- Prepared internal and regulatory financial reports, balance sheets and income statements.
- Interacted with Medicare and other health insurance companies for timely processing of claims payment, post and prior authorization approvals and delivery of quality customer service and results.
- Exceeded clients' expectations by compassionately gathering required medical and work history information to complete claim and authorization applications.
- Documented and communicated timely claims information while supporting accurate outcomes.
Skills
- Excellent knowledge of claims paying and prior/retro authorization processes and needs
- Thorough knowledge of insurance company explanation of benefits (EOBs)
- Expertise in reading and completing UB04 and HCFA billing forms
- Excellent oral, electronic and written skills
- Extensive experience in government and non-government billing guidelines
- Excellent customer services skills
- Very detailed and goal oriented
- Expertise in Microsoft Office, Outlook, Word, Excel and PowerPoint
Additional Skills
- Microsoft Office: Word, Excel, PowerPoint, Outlook, Teams
- Zoom, WebEx, AS400, LinkedIn, Fred Pryor Training
- Avaya, Finesse and Calabrio
Timeline
Medical Case Management Supervisor
NALC Health Benefit Plan
06.2002 - 09.2025
Senior Customer Service Manager
NALC Health Benefit Plan
06.2002 - 09.2025
Claims Supervisor
NALC Health Benefit Plan
06.2002 - 09.2025
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