Whitney Douglas
Molalla
Summary
Detail-oriented insurance professional with four years of experience in claims processing, file review, and regulatory compliance. Proven ability to manage high workloads while maintaining accuracy, consistency, and adherence to company and state guidelines. Strong critical thinking and communication skills with a focus on quality, documentation, and continuous improvement.
Overview
9
9
years of professional experience
Work History
Claims Examiner
California FAIR Plan
Molalla
01.2022 - Current
- Reviewed, evaluated, and processed insurance claims in accordance with company policies, regulations, and contractual guidelines
- Maintained a monthly audit score of 95% or higher
- Managed high-volume workloads while meeting productivity and turnaround standards
- Maintained accurate, detailed documentation on all claim files
- Applied critical thinking to research complex claims and determine appropriate resolutions
- Communicated effectively with customers, clients, and internal departments
- Identified discrepancies, documentation errors, and coverage issues and ensured corrective action
- Consistently met or exceeded internal quality and compliance standards
- Provided informal guidance to peers on best practices and error prevention
- Collaborated with supervisors and cross-functional teams to resolve complex or high-risk claims
Office Manager
Sunshine Dental Care
Hemet
01.2019 - 01.2022
- Managed daily office operations including scheduling, supplies, and equipment
- Resolved customer inquiries and complaints with professionalism and efficiency
- Created and maintained filing systems to ensure accurate recordkeeping
- Trained and onboarded new staff members
- Processed biweekly payroll and supported financial record review
- Utilized multi-line phone systems to support office communications
Dental Office Manager
Aurora Family Dentistry
Aurora
01.2017 - 09.2019
- Streamlined patient scheduling processes to enhance appointment flow and reduce wait times for improved patient satisfaction.
- Implemented electronic health record systems, increasing data accuracy and accessibility for better patient care management.
- Developed and led staff training programs focusing on compliance and best practices, fostering a knowledgeable team environment.
Education
Diploma -
Molalla High School
Molalla, OregonSkills
- Claims Processing & File Review
- Policy Interpretation & Coverage Analysis
- Regulatory Compliance
- Quality & Accuracy focused claims handling
- Workflow optimization
- Internal audits
- Critical Thinking & Investigation
- Documentation Standards
- Time Management & Prioritization
- Cross-Functional Collaboration
- Professional Communication
References
Available upon request
Personal Information
Title: Senior Claims Examiner
Timeline
Claims Examiner
California FAIR Plan
01.2022 - Current
Office Manager
Sunshine Dental Care
01.2019 - 01.2022
Dental Office Manager
Aurora Family Dentistry
01.2017 - 09.2019
Diploma -
Molalla High School