Courtney Phillips
Halifax,NS
Summary
Dedicated and results-driven professional with extensive experience in claims adjudication, training, and process improvement within the healthcare insurance sector. Demonstrated expertise in analyzing and processing complex health insurance claims with 100% accuracy while adhering to policy provisions and provincial guidelines. Subject matter expert with a proven track record in mentoring teams, developing training materials, and fostering collaboration to enhance operational efficiency. Known for critical thinking, problem-solving, and exceptional attention to detail. Committed to continuous improvement and customer-centric decision-making, delivering innovative solutions to streamline claims processes and improve service quality.
Overview
10
10
years of professional experience
Work History
Drug Prior Authorization Adjudicator
Manulife
01.2019 - Current
- Independently evaluated claim submissions for prior authorization eligibility, considering drug criteria, policy provisions, and provincial drug plans, when applicable, with 100% accuracy, demonstrating exceptional attention to detail.
- Communicated with medical professionals, patient support programs, Preferred Provider Networks, and plan member's when required information was missing or unclear.
- Reduced case backlogs by effectively managing workload and meeting strict deadlines for resolution.
- Effectively managed appeals and escalated cases, applying advanced problem-solving skills to resolve complex or contentious issues, always with the customer in mind.
- Ran multiple daily reports using Microsoft Excel and Lists to facilitate claims prioritization and provide accurate data to our referral partners.
- Demonstrated a continuous improvement mindset by proactively identifying problems and proposing solutions to streamline the claims assessment process.
- Provided guidance and training to junior team members across multiple teams.
- Developed and adapted training materials as needed to accommodate diverse learning styles.
- Served as a resource for trainees post-training, offering continued support in applying newly acquired skills in their workplace settings.
Complex Health Insurance Claims Adjudicator
Manulife
12.2014 - Current
- Processed medical claims based upon established claims processing criteria, exceeding quality expectations.
- Managed a high volume of claims daily, consistently meeting deadlines and exceeding productivity targets of 50 claims per day.
- Developed comprehensive understanding of medical terminology for accurate claim processing.
- Identified opportunities for process improvements within the claims department, leading to increased overall efficiency and reduced costs associated with claim reworkings.
- Mastered various proprietary claim processing systems quickly allowing seamless adaptation to new technology initiatives within the organization.
- Completed pre-implementation testing for a new claims adjudication system to assess quality of product.
- Recommended system enhancements and corrections to developers for optimal software performance and usability.
Education
Bachelor of Science - Biology And Psychology
Saint Mary's University
Halifax, NS10.2014
Skills
- Leadership skills
- Claims analysis
- Attention to detail
- Time management
- Critical thinking
- Decision-making
- Problem-solving
- Microsoft Office Suite
Languages
English
Native or Bilingual
Timeline
Drug Prior Authorization Adjudicator
Manulife
01.2019 - Current
Complex Health Insurance Claims Adjudicator
Manulife
12.2014 - Current
Bachelor of Science - Biology And Psychology
Saint Mary's University
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