Uyen (Gwen) Sundy
Seattle,WA
Summary
Accomplished Claim Processing Specialist III at Premera Bluecross, adept in claims analysis and fostering teamwork. Streamlined claim investigations, enhancing department efficiency by 30%. Excelled in critical thinking and claims processing software, significantly improving customer satisfaction and compliance standards.
Overview
16
16
years of professional experience
Work History
Claim Processing Specialist, III
Premera Bluecross
01.2017 - 10.2024
- Mentored junior claim processing specialists, sharing valuable expertise and guidance on career growth within the industry.
- Maintained detailed records for all processed claims, facilitating easy retrieval for future reference or analysis.
- Coordinated cross-functional efforts between various departments during large-scale claim investigations.
- Conducted regular audits of processed claims to maintain a high level of accuracy and compliance with industry standards.
- Provided exceptional support to underwriting teams by carefully reviewing policy applications for adherence to approval guidelines.
- Developed comprehensive reporting systems to track key performance indicators for the claims department.
- Stayed current on industry trends and regulatory changes, informing team members about relevant updates that could impact their work processes.
- Streamlined communication between departments, ensuring timely resolution of complex claims.
- Optimized internal database systems used for storing essential documents throughout the claim lifecycle.
- Improved customer satisfaction by efficiently addressing inquiries and resolving disputes.
- Implemented effective time management strategies within the team, allowing a higher volume of processed claims without sacrificing quality.
- Maintained confidentiality of patient finances, records, and health statuses.
Sr Customer Service Representative
Premera Bluecross
08.2015 - 01.2017
- Provided backup support during peak periods or staff shortages to ensure seamless service delivery to clients at all times.
- Established strong rapport with customers, fostering long-term relationships and repeat business.
- Resolved customer service issues using company processes and policies and provided updates to customers.
- Demonstrated excellent multitasking abilities by managing multiple concurrent tasks while ensuring timely completion.
- Enhanced customer satisfaction by promptly addressing and resolving complex inquiries and complaints.
- Trained and directed new employees in call script use, conflict resolution, and data entry practices to boost customer satisfaction ratings.
- Developed solutions-oriented approaches when faced with challenging situations or dissatisfied customers.
- Escalated issues to proper supervisors when standard processes were not effective.
- Trained new personnel regarding company operations, policies and services.
- Increased efficiency and team productivity by promoting operational best practices.
Credit Analyst
Verizon Wireless
01.2009 - 05.2015
- Assessed credit risk and analyzed financial statements.
- Analyzed customer data such as financial statements to determine level of risk involved for extending credit.
- Analyzed credit scores to determine borrowers' creditworthiness.
- Reviewed credit reports to comprehensively view borrowers' credit history and identify potential red flags.
- Collaborated with cross-functional teams for comprehensive client assessments, supporting informed decisionmaking.
- Streamlined the loan approval process for faster results by implementing an efficient credit scoring system.
- Negotiated payment plans and loan terms with delinquent customers.
Education
Bachelor of Arts - Finance
Cal State Fullerton
Fullerton, CA05.2002
Skills
- Claims Processing Software
- Claims analysis
- Policy Interpretation
- Claims Investigation
- Teamwork and Collaboration
- Problem-Solving
- Time Management
- Attention to Detail
- Multitasking
- Organizing and Prioritizing Work
- Reliability
- Excellent Communication
- Critical Thinking
- Organizational Skills
Timeline
Claim Processing Specialist, III
Premera Bluecross
01.2017 - 10.2024
Sr Customer Service Representative
Premera Bluecross
08.2015 - 01.2017
Credit Analyst
Verizon Wireless
01.2009 - 05.2015
Bachelor of Arts - Finance
Cal State Fullerton