LAUREN NAPOLEON
Sacramento,Ca
Summary
Experienced and organized professional with 10+ years in Customer Service, Claims, and training. Demonstrates strong communication skills and leadership abilities. Self-motivated team player who excels both independently and collaboratively. Currently pursuing a Real Estate License and Project Management Certificate.
Motivated Project Management professional seeking an entry-level position to apply and advance acquired skills in a long-term career with the company.
Overview
10
10
years of professional experience
Work History
Claims Analysis II
Versant Health
01.2020 - Current
- Contributed to project assistance, claim support provision, coordination of provider check validation, resolution facilitation, identification of system issues and collaboration on payment matters.
- Reviewed customer claims, identified discrepancies and determined appropriate course of action.
- Conducted investigations to gather evidence in support of claims resolution.
- Assessed medical records for coverage eligibility and benefit accuracy.
Product Contracting Specialist
Blue Cross Blue Shield - Contract Assignment
01.2019 - 01.2020
- Contributed to large group plan enrollment processes, conducted data analytics to drive decision-making, and handled file creation for processing
- Developed and implemented procedures for contract administration.
- Assessed customer requirements to identify specific contractual needs.
- Reviewed solicitations, contracts and other legal documents in order to ensure compliance with applicable laws and regulations.
- Negotiated terms and conditions of contracts on behalf of the company.
MHN Claims Analyst
Health Net
01.2018 - 01.2019
- Demonstrated strong problem solving skills while deescalating tense situations with irate customers.
- Reviewed customer claims, identified discrepancies and determined appropriate course of action.
- Conducted investigations to gather evidence in support of claims resolution.
- Analyzed claim data to identify trends and recommend process improvements.
Document Processing Specialist (Temp Job)
Maximus
Folsom, Ca
05.2017 - 08.2017
- Reviewed and processed incoming documents to ensure accuracy, completeness, and compliance with regulations.
- Resolved discrepancies in documentation by obtaining missing information from sources such as clients or other departments.
- Created new accounts based on customer requests and verified all data entered into the system.
Front Desk
Best Western
07.2016 - 01.2017
- Greeted visitors and provided them with information about the company.
- Managed incoming calls, emails, and inquiries from clients regarding services and products.
- Maintained records of customer interactions and transactions, recording details of inquiries, complaints, and comments.
- Processed payments using cash registers or point-of-sale systems.
- Organized front desk operations including scheduling appointments and managing calendars.
Customer Service
LLJ Management
10.2015 - 01.2016
- Customer Service, Inventory, Cashier, Microsoft, Communications
Front Desk
Liberty Inn
03.2015 - 08.2015
- Reservations, Data Entry, Microsoft, Night Vision, Customer Service, Communications
Education
High School Diploma -
Thomas Downey High School
01.2008
Skills
- Policy Interpretation
- Accounting spreadsheets
- Claims history analysis
- Analytical thinking, decision making and problem solving skills
- Training and effectively working with other representatives
- Data Entry
- Data Interpretation
- Insurance knowledge
- Interpersonal and written communication
- Critical Thinking
- Claim Form Analysis
Charactertraits
- Self-motivated
- Hardworking
- Organized
- Strong communication skills
- Leadership
- Team player
Timeline
Claims Analysis II
Versant Health
01.2020 - Current
Product Contracting Specialist
Blue Cross Blue Shield - Contract Assignment
01.2019 - 01.2020
MHN Claims Analyst
Health Net
01.2018 - 01.2019
Document Processing Specialist (Temp Job)
Maximus
05.2017 - 08.2017
Front Desk
Best Western
07.2016 - 01.2017
Customer Service
LLJ Management
10.2015 - 01.2016
Front Desk
Liberty Inn
03.2015 - 08.2015
High School Diploma -
Thomas Downey High School
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