Christiana Booty
Tucson
Summary
Experienced professional with a strong work ethic, adaptability, and reliability. Seeking a position that embraces diversity and presents new challenges. Passionate about collaborating with individuals from diverse backgrounds. Eager to contribute skills as a diligent worker and fast learner.
Overview
7
7
years of professional experience
Work History
Lead Claims Analyst
Centene Corporation
02.2022 - Current
- Train, mentor and develop claims analysts as a reinforcement of claims training
- Assist in reviewing, investigating, adjusting, and resolving all pending claims; especially complex claims, claims appeals, inquiries, and inaccuracies in payment of claims. Serve as first point of escalation
- Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis
- Assist in creating workflows for the department and support team members in understanding changes in work processes
- Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Demonstrate a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Provide oversight and support to ensure that Claims Analysts apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied
Advanced Claims Analyst
Centene Corporation
01.2018 - 02.2022
- Process first time claims with added complexity
- Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied
- Research and determine status of medical related claims
- Resolve claims related to adjustments, provider calls, reconsiderations and appeals
- Communicate with stakeholders’ important information needed for the successful processing of claims with added complexity
- Maintain appropriate records, files, documentation, etc.
- Meet and maintain department production and quality standards
- Performs other duties as assigned
- Complies with all policies and standards
Education
High School Diploma - Fine Arts
Tucson High Magnet School
Tucson, AZ05.1997
Skills
- Claims
- Claims analysis
- Interpersonal and written communication
- Policy interpretation
Timeline
Lead Claims Analyst
Centene Corporation
02.2022 - Current
Advanced Claims Analyst
Centene Corporation
01.2018 - 02.2022
High School Diploma - Fine Arts
Tucson High Magnet School
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