Tracy Rose
Blue Shield of CA
El Dorado Hills,CA
23
years of professional experience
Experienced Claims Processor with expertise in claims analysis, documentation review, and problem resolution. Proven ability to accurately resolve complex claims, provide support and guidance to team members, and collaborate across multiple departments to achieve efficient and accurate claim outcomes.
Work History
HEAT Rework Processor, Advanced
22 Years 10 Months- Managed complex claims processing while maintaining accuracy.
- Collaborates across internal departments to gather claim issue information, verify accuracy, and finalize case resolutions.
- Applies HIPAA and confidentiality standards when handling sensitive member information and correspondence.
- Mentors team members on claims processing and workflows.
- Peer Audited HEAT, general suspense, and AGD.
- Responsible for maintaining the CTT.
- Investigates escalated claims-related issues, coordinated resolution actions, and maintained strong working relationships with PR representatives.
- Assisted lead in managing inventory to maintain accurate availability and support operations.
- Participates actively in team meetings to maintain positive team morale, provides constructive feedback and shares knowledge with colleagues.
Education
High School Diploma
Skills
Strong work ethic
Continuous learning mindset
Claims investigation
Time management
Excellent communication
Organizational skills
Timeline
HEAT Rework Processor, Advanced
Blue Shield of CA
12.2003 - CurrentRead More
El Dorado High School
High School Diploma
Read More