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Click here or scroll down to respond to this candidate Candidate's Name
Street Address Shagbark Ln
Hazel Crest, IL
Street Address
Phone: PHONE NUMBER AVAILABLE
EMAIL AVAILABLE
Goal and result driven professional with a proven track record to excel in a highly
competitive market. Exceptional ability to learn & adapt to new workflows and
procedures. Highly independent with strong product knowledge in customer service,
claims processing and provider relations in a managed care environment.
Education:
2012-2014 American InterContinental University Hoffman Estates, IL
B.A.Business Administration (Human Resources Management)
Experience
2023 Molina Healthcare
Senior Claims Examiner/Customer Service
Maintained priority phone line dedicated to priority groups
Processed complex/high dollar claims
Manually calculated border, LTSS & SCA claims
Multi state processing (California & New York)
Created tickets for overpaid/underpaid claims
Maintained Sepsis queue & manually priced claims when needed
2016-2023 Community Care Alliance of Illinois/ClearSprings Healthcare
Senior Claims Adjuster/Customer Service
Customer service in high volume call center (members &
providers) (medical & dental)
Processed adjustments from call tracking request
Verified & updated provider contracts
Appeals including researching & resolving disputes
Processed high $/complex claims
Audit claims and finalize payment reports prior to check run
System configuration (tested new Sprints/system fixes prior to
implementation
Assisted with CMS audit request verifying contracts and correct
payment
Worked closely with Medicaid for final audit close out
Created & maintained overpayment/underpayment records
2011-2016 Navigant Consultants
Human Resource Assistant
Created new hire packets
Background checks
I-9 verification
Prepared training materials
Employee customer service
Timesheet/Payroll
Maintained employee records/expense report
Special Skills: Customer Service, Numerous Claims Billing Systems, Numerous Pricing
Platforms, Microsoft Office, Medical Terminology, 20 years Managed Care experience, Learn
Point, People Soft, QPro Care, Avaya, Project Coordination & Problem Solving
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