Elizabeth Gagnon
Springfield
Summary
Experienced claims analyst with customer service experience looking to secure a long term position within a strong organization where my skills and experience will be an asset to the company, with the opportunity to grow and expand my industry knowledge.
Overview
16
16
years of professional experience
Work History
Claim Team Lead
Wellfleet Insurance LLC
10.2022 - Current
- Communicate with Clients, Policyholders and Agents as required
- Assist Account Managers with questions as necessary
- Works with staff on professional development and identifying career goals and aspirations of team members.
- Review of reports (audit, inquiry etc.…) to identify trends and areas for process improvement and identifies additional training opportunities.
- Contribute agenda items for weekly claims meeting to foster a culture of focusing on ways we can improve our
services to better meet the needs of our customers. - Must have thorough understanding of all equipment, methods, and procedures.
- Good oral and written communication skills and is expected to give clear communications to staff.
- Works with trainer to develop and implement appropriate training programs for Claims personnel to maximize their
performance and skills. - Maintain confidentiality.
- Ability to handle difficult situations and persons in a positive and professional manner.
- Ability to motivate others to reach their potential and drive results
Self-motivated with the ability to work independently, with very little direction. - Assist Claims Supervisor with performance reviews
Ensure staff are processing claims and requests accurately and timely. - Perform random Claim Audits as needed.
- Ability to handle special projects.
- Establish and maintain a high level of positive working relationships with internal and external customers
Keep current with benefits.
- Work with leadership to ensure KPM’s and operating plan deliverables are met.
- Work with leadership to ensure client specific and company SLA’s are met.
- Keep management informed of problems and issues
- Handle escalated issues
Customer Service and Claims Specialist
Wellfleet Insurance LLC
11.2009 - 10.2022
- Handles several different colleges in various states
- Knowledge of ICD-9 and CPT-4 coding to process claims according to plan benefits
- Promoted to Claims Specialist September 2011
- Maintain 99% accuracy, and produce minimum 225 claims daily
- Calling facility and providers to discuss billing process of claims
- Verify PPO pricing
- Answer incoming calls in 30 seconds or less
- Help with the Explanation of Benefits with either Member or Provider
- Ability to read UB-92, HCFA, and medical records with accuracy
- Accurately enter ICD-9 and CPT-4
Education
High school diploma -
Pioneer Valley Regional School
Northfield, MADigital Photography
Springfield Technical Community College
Springfield, MA06.2008
Skills
- Extensive Microsoft Office knowledge including Excel and Word
- Luminx Operations systems
- Attention to detail
- Customer focus
- Relationship building
- Client communication
- Work assignment delegation
- Teamwork and collaboration
Timeline
Claim Team Lead
Wellfleet Insurance LLC
10.2022 - Current
Customer Service and Claims Specialist
Wellfleet Insurance LLC
11.2009 - 10.2022
Digital Photography
Springfield Technical Community College
High school diploma -
Pioneer Valley Regional School
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