Tynila Malloy
Tampa,FL
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
2
2
years of professional experience
Work History
CLAIMS ANALYST
Life Protect 24/7
02.2024 - 08.2024
- Determined coverage outlined in benefits description and assessed documentation from healthcare providers to delegate responsibility of claim appropriately
- Reviewed questionable claims by conducting analytical approach to resolve claim effectively
- Identified error payments for denial and pay codes to allocate to correct teams
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims
- Facets Production 122-160 day
CLAIMS AUDITOR
Health plan one
12.2022 - 02.2024
- Researched issues related to claims processing to identify origins and implement corrective solutions
- Provided root cause analysis to provide reconciliation on questionable claims that were inaccurately adjudicated
- Developed Trainings for New Hires to ensure auditing protocols were adhered and followed to it's entirety
- Reviewed new files to determine current status of claim payment and or adjudication to prevent reconciliation
- processed 80-150 claims audits per day depending on medical queues
Education
High School Diploma -
Wharton High School
Tampa, FL06-2023
Skills
- Epic
- EMR/EHR
- Xcelys
- Maces
- QNXT
- SQL
- Facets
- Networx Pricer
Affiliations
- Available upon request
Timeline
CLAIMS ANALYST
Life Protect 24/7
02.2024 - 08.2024
CLAIMS AUDITOR
Health plan one
12.2022 - 02.2024
High School Diploma -
Wharton High School
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