Emma Quinley
12633 Fair Oaks Blvd. #233
Summary
Results-driven Claims Analyst at Centene Corporation, specializing in claims analysis and regulatory compliance. Demonstrated success in enhancing data integrity and effectively resolving conflicts. Expertise in collaborating with cross-functional teams to streamline processes, ensuring accuracy in claims processing while upholding exceptional customer service standards. Career goals include further advancing in claims management and contributing to organizational efficiency.
Overview
15
15
years of professional experience
Work History
Claims Analyst
Centene Corporation
4151 E Commerce Way
06.2019 - Current
- Analyzed claims for accuracy and completeness according to company guidelines.
- Reviewed documentation to ensure compliance with regulatory requirements and policies.
- Collaborated with team members to resolve discrepancies in claims processing.
- Maintained detailed records of claims activities in the company database.
- Followed all company procedures to keep data confidential.
- Reviewed customer claims, identified discrepancies and determined appropriate course of action.
- Ensured compliance with federal and state regulations governing insurance industry operations.
- Evaluated requests for additional benefits or changes in existing coverage levels.
Call Center Representative
Health Net, Centene
Rancho Cordova
06.2011 - 06.2019
- Managed high-volume inbound calls from members and healthcare providers.
- Assisted customers with inquiries about health insurance plans and benefits.
- Documented member interactions accurately in the customer relationship management system.
- Resolved issues and escalated complex cases to appropriate departments.
- Provided support during open enrollment periods for health plan selections.
- Trained new representatives on call handling procedures and system usage.
- Maintained knowledge of policies, procedures, and updates in healthcare regulations.
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
- Answered incoming calls from customers and provided assistance with product inquiries, billing questions, and other customer service related issues.
- Maintained high levels of professionalism while interacting with customers via phone or email.
- Updated customer accounts, addresses and contact information within call management databases.
- Resolved customer complaints in a timely manner to ensure customer satisfaction.
- Navigated through computer systems to review information and respond appropriately to callers.
- Maintained strong call control and quickly worked through scripts to address problems.
- Engaged actively with callers, confirming or clarifying information and diffusing anger.
- Met or exceeded call speed, accuracy and volume benchmarks on consistent basis.
- Offered resolutions to de-escalate calls and solve customer issues.
- Delivered fast, friendly, and knowledgeable service for routine questions and service complaints.
Education
Associate of Arts - Medical Office Administration
Heald College
CA10-2010
Skills
- Claims analysis
- Regulatory compliance
- Documentation review
- Data integrity
- Benefits evaluation
- Customer relationship management
- Conflict resolution
- Claims processing
- Detail orientation
- Team collaboration
- Interpersonal and written communication
- Time management
Affiliations
- Director of Singles Ministry at my Church
- Praise and Worship leader
- Community Activity Director (Feeding the Community)
- Photographer
Accomplishments
- Received certification as Minister of the Gospel
- Out reach certificate
References
References available upon request.
Timeline
Claims Analyst
Centene Corporation
06.2019 - Current
Call Center Representative
Health Net, Centene
06.2011 - 06.2019
Associate of Arts - Medical Office Administration
Heald College