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Work Background
MultiPlanClaims Investigator
Mar. 2021United StatesIn my role as a Claims Investigator at MultiPlan, I am responsible for managing a high volume of healthcare claims to maximize savings opportunities. I analyze and interpret data for accuracy and recoverability, while consistently reviewing contracts for guidelines and updates. My work helps ensure compliance with regulations and maintain high-quality standards. I also assist in training new hires on audits, provider, and internal systems. Well-versed with Medicare, Medicaid, and Commercial lines of business.
OptumAnalytic Development/Payment Accuracy
Jul. 2019 - Feb. 2021United StatesIn my role as an Analytic Development/Payment Accuracy specialist at Optum, I reviewed medical paid claims to ensure accuracy and compliance with provider contracts and policies. By employing data mining techniques, I analyzed and audited hospital and physician claims, promoting a positive team environment based on critical thinking and intelligence sharing. I also collaborated cross-functionally with other departments, incorporating HIPAA guidelines to ensure compliance and efficiency.
COTIVITI USA, LLCClaims Auditor (Layoff/Career Break)
Feb. 2013 - Feb. 2019United StatesIn my role as a Claims Auditor at COTIVITI USA, LLC, I meticulously audited client data for claim overpayments, ensuring compliance with contracts and CMS guidelines. I also played a key role in assisting with new contract start-ups and consistently met monthly recovery goals.
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