Lisa Jacobs
Ayer
Summary
Claim Retention and Recovery Specialist with a track record of processing complex insurance claims and financial transactions with over 99% accuracy. Demonstrated expertise in resolving refunds, returned checks, and retention issues while collaborating effectively with finance, sales, client services, and provider relations.
Overview
18
18
years of professional experience
Work History
Claim Retention and Recovery Specialist
DentaQuest
Wellesley
01.2020 - Current
- Processed advanced claims with 99% accuracy, ensuring compliance with corporate standards.
- Managed follow-up queues for check statuses, achieving timely resolutions on outstanding items.
- Independently posted refund checks and resolved returned or undeliverable checks efficiently.
- Collaborated with sales, client services, and finance to address claim payment issues.
- Reviewed retention balances, preparing quarterly and annual reports in conjunction with Finance.
- Assisted Claims Technical Team with miscellaneous transactions as necessary.
- Coordinated with Finance to ensure proper handling of unidentified checks.
- Documented work processes and tracked turnaround times using Windward and Excel tools.
Claim Administrator
DentaQuest
Wellesley
11.2013 - 01.2020
- Performed highest-level claims processing across multiple business units with 99%+ accuracy.
- Independently resolved complex claim adjustments including refunds, corrections, follow-ups, COB, orthodontia, retention, and check returns.
- Adjusted complex claims to final resolution in alignment with corporate goals.
- Documented work and tracked outstanding items and turnaround times using Windward and Excel.
- Collaborated with providers, members, clients, sales, client services, and provider relations to resolve escalated issues.
- Communicated claim trends to leadership to support process improvements.
- Partnered with management to increase auto-adjudication rates and self-service utilization.
- Led workflow process mapping and resolution of ad hoc claim scenarios.
- Served as backup to the call center and Claim Research & Resolution Team during peak periods.
Advanced Claim Processor
DentaQuest
Wellesley
01.2008 - 11.2013
- Consistently processed advanced and complex claim queues with 99% or greater accuracy using proprietary claim processing software.
- Independently resolved advanced claim scenarios including COB, orthodontia (ORTHO), TPL, and manual pricing.
- Adjusted complex claims to meet corporate and financial goals.
- Served as backup to the call center, assisting providers and members during peak volumes.
- Supported the Claim Administration Team by processing adjustments, posting refund checks, and completing follow-ups.
- Assisted the Claim Research & Resolution Team by researching and resolving complex claim issues.
- Served as backup to Team Lead, assisting with daily reporting and workload management.
- Successfully completed special projects and higher-complexity assignments as requested.
Education
High School Diploma -
Matignon High
Cambridge, MA06-2002
Skills
- Refund management
- Attention to detail and accuracy
- Strategic problem solving
- Verbal and written communication
- Self-motivation and adaptability
- Productivity and time management
- Critical thinking
- Attention to detail
Timeline
Claim Retention and Recovery Specialist
DentaQuest
01.2020 - Current
Claim Administrator
DentaQuest
11.2013 - 01.2020
Advanced Claim Processor
DentaQuest
01.2008 - 11.2013
High School Diploma -
Matignon High