Open to opportunities

Kim’E Kim

@kimekim

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Skilled claims processing professional with expertise in problem solving.

United States

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What I'm looking for

I am looking for a role that values collaboration and offers growth opportunities in claims management.

I am a dedicated professional with extensive experience in claims processing and customer service, particularly within the healthcare sector. Over the years, I have honed my skills in complex problem-solving, ensuring that I can effectively address and resolve escalated claims issues. My role at Anthem Inc. has allowed me to lead project teams and act as an operational expert, enhancing the efficiency of our processes.

Throughout my career, I have been responsible for analyzing and documenting claims issues, utilizing various software tools such as Facets and NextGen. My ability to communicate effectively, both verbally and in writing, has been crucial in preparing correspondence for providers and coordinating resolutions. I take pride in my strong organizational skills and my commitment to delivering high-quality service to both internal and external customers.

Experience

Work history, roles, and key accomplishments

Provider Payment Reconsideration Analyst II

Anthem, Inc.

Jan 2019 - Feb 2023 (4 years 1 month)

Responsible for reviewing and processing complex escalations and state complaints, coordinating timely resolutions. Analyzed provider disputes and utilized guidelines to conduct extensive research on claims and medical records.

Research Customer Service Microsoft Office Communication Project Management Problem Solving Time Management Nextgen Software

Grievance, Appeals Analyst I

Anthem, Inc.

May 2014 - Jan 2019 (4 years 8 months)

Reviewed and processed non-complex grievances and appeals, conducting extensive research on claims and medical records. Communicated project resolutions to providers and internal customers.

Research Customer Service Communication Problem Solving Time Management Microsoft Office Grievances Appeals

Internal Resolution Specialist (IRU)

Anthem, Inc.

Apr 2012 - Feb 2014 (1 year 10 months)

Handled internal resolutions for claims issues, ensuring compliance with provider contracts and reimbursement policies. Prepared correspondence and communicated resolutions effectively.

Research Customer Service Communication Problem Solving Time Management Microsoft Office Contract Review

Claims Analyst III

Anthem, Inc.

Apr 2007 - Apr 2012 (4 years 11 months)

Analyzed and processed claims, ensuring accuracy and compliance with policies. Conducted research on complex claims issues and communicated findings to stakeholders.

Research Customer Service Communication Problem Solving Time Management Microsoft Office Compliance Policies Data Analysis

Medical Claims, Benefits Processor

Humana, Inc.

Jan 2006 - Apr 2007 (1 year 3 months)

Processed medical claims and benefits, ensuring accuracy and compliance with healthcare regulations. Assisted in resolving claims-related inquiries from providers and members.