Mor Cheng
Sacramento,California
Summary
Experienced health care professional with 5+ years in the health care industry. Seeking an opportunity to leverage my customer service and claims experience to enhance my education and professional skills in a stable and dynamic workplace.
Professional claims analyst with proven track record in evaluating, processing, and resolving insurance claims. Strong focus on team collaboration and adaptability, ensuring seamless operations and optimal outcomes. Highly skilled in data analysis, risk assessment, and customer service, consistently delivering reliable and efficient results. Known for excellent problem-solving abilities and maintaining high standards in all tasks.
Overview
17
17
years of professional experience
Work History
Claim Analyst
MHN Centene, Corp.
12.2018 - Current
- Process claims of all sequence levels paying or denying them according to contracted rates and healthcare regulations as well as taking on a variety of special projects for providers of all levels.
- Consistently meet performance metrics for claims processing
- Verify patient eligibility to ensure proper payment of claims
- Participate as an Mentor assisting with inquiries from peers; providing answers to process and procedure questions as well as best practices to increase the team’s skill set and reduce errors
- Research and resolve escalated provider claims for seamless resolution
- Proactively identify error trends within the work group; drive solutions
- Analyzed complex claims to ensure compliance with regulatory standards
- Collaborated with cross-functional teams to resolve claim disputes effectively
- Developed and implemented process improvements to enhance claims processing efficiency
- Maintained strict confidentiality with all personal data as per company guidelines.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Reduced claims processing time by implementing efficient analytical techniques and strategies.
Claim Examiner
Kelly Services Centene
11.2017 - 12.2018
- Process claims of all sequence levels paying or denying them according to contracted rates and healthcare regulations as well as taking on a variety of special projects for providers of all levels.
- Consistently meet performance metrics for claims processing
- Respond to calls from providers inquiring on payments or process
- Verify patient eligibility to ensure proper payment of claims
- Audit peer claims to ensure accuracy of transactions and payments to providers
- Participate as an SME (Subject Matter Expert) assisting with inquiries from peers; providing answers to process and procedure questions as well as best practices to increase the team’s skill set and reduce errors
- Train team members on new processes and policies
- Research and resolve escalated provider claims for seamless resolution
- Proactively identify error trends within the work group; drive solutions
Med Doc’s
04.2017 - 11.2017
- Accurately enter patients information into user database
Customer Service Desk
Wal-Mart
08.2014 - 01.2015
- Assisted customer’s with returns and exchanges
- Processed money orders and money grams
- Handled incoming calls from customers and vendors
- Responsible for outcalls to customers and vendors
Customer Service
Subway
04.2013 - 09.2014
- Accurately handled customer’s orders in person/phone
- Responsible for processing/making sandwich breads
- Managed and refilled sandwich stand for orders
- Responsible for opening/closing prep
Caregiver
Maxim Healthcare
05.2009 - 11.2012
- Assisted with patient's orders
- Assisted with patients daily activities
- Responsible for patient's personal hygiene (physical care)
Education
Health Administrator -
University Of Phoenix
10-2014
Certified Nurse Assistants -
Merced College
09-2010
Skills
- Strong written and verbal communication skills
- Ability to multitask/work in complex environments
- Ability to work independently with minimal supervision
- Strong leadership skills
- Strong presentation skills
- Effective problem solver
- Claims
- Claims analysis
- Interpersonal and written communication
- Policy interpretation
- Data interpretation
- Claim investigation
- Proficient in [software]
Languages
English
Timeline
Claim Analyst
MHN Centene, Corp.
12.2018 - Current
Claim Examiner
Kelly Services Centene
11.2017 - 12.2018
Med Doc’s
04.2017 - 11.2017
Customer Service Desk
Wal-Mart
08.2014 - 01.2015
Customer Service
Subway
04.2013 - 09.2014
Caregiver
Maxim Healthcare
05.2009 - 11.2012
Health Administrator -
University Of Phoenix
Certified Nurse Assistants -
Merced College