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Click here or scroll down to respond to this candidateHigh Ridge, MO 63049 PHONE NUMBER AVAILABLE EMAIL AVAILABLECandidate's Name
Experienced Type Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 25 years of experience and willingness to take on any challenge. Rational operations analyst with 10 years of experience enhancing operations for organizations through information systems solutions. Proven track record of transforming specific business goals related to growth and efficiency improvements into new system designs. Knowledgeable innovator known for recommending new technologies to enhance existing systems and introduce new systems.PROFESSIONALSUMMARYSKILLS Time Management Decision Making Multitasking Conflict Resolution Claims Analysis Problem Solving Insurance Knowledge Organizational Skills Microsoft Office Critical Thinking Process Improvement Data Analysis Claims Processing Attention to Detail Analytical Skills Investigation Techniques Policy InterpretationClaim AmountCalculationsTeamwork andCollaboration New Policies Processing Claims Adjustment Policy Review Large-Sum Computations Coverage DeterminationDocumentationProcessingUnderstanding of MedicalTermsCLAIMS OPERATIONS SPECIALIST 06/2021 to 09/2023HealthAxis, Tampa, FLPHARMACY OPERATIONS ANALYST 11/2020 to 06/2021WORK HISTORYEnhanced claims processing efficiency by implementing streamlined workflows and procedures.Reduced claim processing time by optimizing communication between departments and stakeholders.Managed high-volume claims operations, ensuring timely resolution and accurate payments. Collaborated with cross-functional teams to improve overall claims management processes. Conducted thorough investigations of insurance claims, resulting in accurate adjustments and settlements.Maintained compliance with industry regulations through diligent monitoring and documentation of claims activities.Facilitated interdepartmental collaboration on high-priority cases, ensuring seamless communication and expedited resolutions.Elixir Solutions, Canton, OHCLAIM SYSTEMS SPECIALIST 2 07/2013 to 12/2019Magellan Health, Maryland Heights, MOIncreased efficiency by streamlining data analysis processes and implementing automation tools.Identified trends and patterns in large datasets, leading to actionable insights for business growth.Developed new analytical models that improved forecasting accuracy and reduced risk exposure.Enhanced team collaboration by providing clear communication of complex findings through visualizations and reports. Improved system efficiency by optimizing hardware and software configurations. Streamlined system processes for enhanced performance and user satisfaction. Reduced downtime with proactive maintenance and routine system checks. Enhanced security measures, protecting sensitive data from potential breaches. Collaborated with cross-functional teams to develop customized solutions for unique business needs.Conducted thorough analyses of existing systems to identify areas for improvement and optimization.Identified and resolved technical issues quickly, minimizing disruptions to operations and maintaining high service levels.University of Evansville, Evansville, INAccountingMaryville University of Saint Louis, St Louis, MOAccountingEDUCATION |
