AMAriel M
@arielm
Seasoned Senior Claims Benefit Specialist with expertise in healthcare claims.
United StatesWhat I'm looking for
I am a seasoned and results-driven Senior Claims Benefit Specialist with extensive experience in medical claims adjudication, benefits analysis, and appeals resolution. My career has been marked by a commitment to delivering exceptional service while ensuring claims integrity and optimizing operational performance. I have a proven track record of handling complex claims across multiple lines and have been recognized for my ability to exceed performance targets consistently.
In my current role at United Health Group, I have achieved a remarkable 99% accuracy in processing and analyzing claims. I work closely with appeals and grievances teams to resolve escalated claims issues and have contributed to system testing for claims configuration updates. My leadership skills shine through as I train junior staff and serve as the go-to expert for interpreting complex benefit plans. I am passionate about continuous process improvement and have successfully reduced average claim resolution time by 30% through effective redesign initiatives.
Experience
Work history, roles, and key accomplishments
Senior Claims Benefit Analyst
United Health Group
Jan 2023 - Present (2 years 5 months)
Processed and analyzed claims across multiple benefit plans, achieving 99% accuracy and exceeding performance targets. Collaborated with the appeals team to resolve escalated claims issues and participated in system testing for claims updates.
Claims Specialist
Walmart
Mar 2023 - Mar 2024 (1 year)
Processed a high volume of claims while maintaining 98% accuracy. Supported appeal investigations and participated in cross-training to streamline member inquiries, recognized for outstanding performance.
Senior Claims Benefit Specialist
BlueShield BlueCross
Mar 2023 - Mar 2024 (1 year)
Adjudicated complex medical claims across various lines, serving as an escalation point for critical issues. Conducted audits and collaborated with teams to resolve discrepancies, improving claim resolution time by 30%.
Customer Service Representative
William Sonoma
Apr 2020 - Dec 2022 (2 years 8 months)
Managed customer inquiries through various platforms, enhancing customer satisfaction and retention. Implemented a new CRM system and developed training programs, achieving significant efficiency gains.
Education
Degrees, certifications, and relevant coursework
LCLawson State Community College
Bachelor of Science, Health Administration
2024 -
Pursuing a Bachelor of Science in Health Administration, focusing on the management of healthcare systems and services, including the analysis of healthcare policies and practices.
Huffman High School
High School Diploma
2019 - 2021
Completed high school education with a focus on foundational academic skills, preparing for further education and career opportunities.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
Skills
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