Medical Insurance Verification Specialist I Claims AnalystMedical Insurance Verification Specialist I Claims Analyst

Key Achievements:

**** Responsible for the coordination of payroll processing operations for a team. Monitors workflow, team assignments, and processing deadlines. -Lead and develop a team of payroll specialists through coaching, regular one-on-ones, and team meetings. Ensure team engagement and performance in alignment with company goals. -Oversee daily payroll activities, ensuring deadlines are met and tasks are prioritized. Address escalations and support the team during high-volume periods or absences. -Conduct audits to maintain accuracy and quality. Provide timely feedback to team members and identify opportunities for improvement in workflows. -Organize training sessions with support from the Quality Assurance team. Onboard and guide new team members while helping current staff achieve their professional development goals. -Prepare payroll reports for management, finance, and compliance purposes. -Coordinate with HR and finance teams to ensure seamless integration of payroll and benefits data. -Stay updated on changes to payroll regulations and ensure adherence to legal requirements. -Assist in year-end payroll activities, including tax filings

Key Achievements:

-Validate claim status, claim liability, and availability of coverage - Accurately and efficiently reviewing contracts, researching healthcare provider claims, thoroughly documenting investigation results, and identifying and implementing appropriate and effective resolution strategies. -Handle the review and assessment of clinical denials, including review of patient medical information, patient account documents, patient account history, company historical data, provider contracts, and regulations as appropriate. He/she will draft focused, successful appeals, meet, and confer documents, IRO submissions, and when necessary, assist with legal submissions on clinical issues. -Ensure compliance with the Health Insurance Portability and Accountability Act -Perform special projects as requested or as assigned by the pre-litigation services manager -Research and analyze information gathered through investigation to identify reimbursement issues, develop solutions, and initiate appropriate claim resolution strategies -Research and analyze information gathered through investigation to identify reimbursement issues, develop solutions, and initiate appropriate claim resolution strategies -Review and validate coding, Process pricing claims -Understand concepts of coverage, insurance contract interpretation, and reimbursement methodologies

Key Achievements:

-Mentored and coached team members to ensure successful performance. -Consistently meets auth completion rate. -Motivated team to achieve optimal results through effective communication and interpersonal skills. -Attendance and volume management. -Identifying problems and addressed by submitting learning requests. -Corresponded with US and India partners for challenging situation.

Key Achievements:

-Demonstrated excellent customer service skills, providing assistance to Flight Attendants pay, dispute and inquiry in a timely and professional manner. -Processed United Airlines FA payroll accurately and on time each month. -Daily processing of Occupational Injury Pay, Sick Pay, Holding Pay, Purser Pay, Galley Pay and other additional pay that Flight Attendants are entitled. -Analyzed discrepancies between pay register and payroll reports for accuracy. -Showed employees' arrival and departure times. -Kept informed about changes in tax and deduction laws that applied to payroll process.