LifeWithSliim User
@lifewithsliimuser
Detail-oriented healthcare claims and fraud analyst specializing in claims review and compliance.
United StatesWhat I'm looking for
I am a healthcare claims and fraud analysis professional with over four years of focused experience reviewing high-volume medical claims, resolving denials, and identifying billing inconsistencies. I bring strong knowledge of ICD-9 and CPT coding, HIPAA compliance, and payer policy application to ensure accurate claim adjudication.
Throughout remote roles at CVS/Aetna, UnitedHealth/Optum, and Equifax, I consistently met productivity and quality benchmarks while supporting payment integrity, documentation standards, and appeals processes. I have a proven track record detecting fraud, waste, and abuse indicators and escalating findings to support compliance and investigation teams.
I combine a customer-service orientation with rigorous data-entry and quality-assurance skills, maintaining meticulous documentation and collaboration across teams. I am adaptable to remote and hybrid environments and committed to improving claims accuracy and reducing denials.
Experience
Work history, roles, and key accomplishments
Claims Specialist
CVS Health / Aetna
Dec 2023 - Present (2 years 2 months)
Processed high-volume medical claims with accuracy and compliance, resolved complex claims issues to ensure timely payments, and improved customer satisfaction through clear communication and issue resolution.
Hairstylist
Self-Employed
Jan 2018 - Present (8 years 1 month)
Managed client records, scheduling, payments, and confidential information while maintaining regulatory and sanitation standards, demonstrating strong attention to detail and customer service.
Claims Processor
UnitedHealth Group (Optum)
Jul 2021 - Dec 2023 (2 years 5 months)
Reviewed and analyzed high-volume medical claims for accuracy and payer compliance, identified coding discrepancies and duplicate claims, and supported payment integrity and HIPAA-compliant documentation efforts.
Investigated denied medical claims to identify root causes such as coding errors and documentation gaps, processed appeals per regulatory guidelines, and flagged recurring denial trends to reduce future errors.
Education
Degrees, certifications, and relevant coursework
University of Phoenix
Undergraduate Studies
Undergraduate studies in progress at University of Phoenix.
Queensborough Community College
College Credits
Completed 36 college credits at Queensborough Community College.
Voyages Preparatory High School
High School Diploma, General Education
High school diploma from Voyages Preparatory High School.
Availability
Location
United StatesAuthorized to work in
Job categories
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