Angela Herron
Lexington
Summary
Analytical professional specializing in claims processing and investigation. Adept at developing strategies for complex claim resolution and maintaining regulatory compliance, ensuring high-quality service and customer satisfaction.
Overview
10
10
years of professional experience
Work History
Senior Integrated Claims Analyst
New York Life Insurance Co
Lexington
06.2023 - Current
- Analyzed complex claims to ensure compliance with company policies.
- Managed escalated cases involving high-value claims or multiple parties involved.
- Reviewed appeals filed by claimants who were dissatisfied with initial decisions made concerning their cases.
- Ensured compliance with federal and state regulations governing insurance industry operations.
- Provided guidance to customers regarding their rights and obligations under policy terms.
- Developed strategies for resolving complex claims issues.
- Investigated and analyzed requirements to improve timeliness of reports to customers.
- Conducted training sessions for new hires on claims processing and company protocols.
- Documented all claims activities clearly and concisely in the claims management system.
- Reviewed documentation to verify accuracy and completeness of claims submissions.
- Mentored junior analysts on best practices in claims processing and analysis.
- Developed training materials for new employees in claims management procedures.
- Streamlined workflow processes to enhance claim resolution efficiency and effectiveness.
- Communicated with policyholders to clarify information and resolve inquiries promptly.
- Ensured proper documentation was maintained according to established procedures.
- Provided technical guidance to junior analysts regarding interpretation of contracts and other related matters.
- Prepared reports summarizing the findings of investigations into potential fraudulent activities.
- Participated in training sessions designed to improve knowledge base regarding insurance products.
- Resolved complex claim issues by examining evidence, analyzing legal documents, and conducting investigations.
- Developed business relationships with clients to ensure satisfaction with services provided.
- Reviewed, researched and evaluated customer claims to determine coverage under policy provisions or applicable laws.
- Monitored performance metrics such as cycle time, customer service ratings, loss ratios for effective decision making.
- Drafted correspondence concerning claim status updates or settlement offers for customers.
- Performed administrative tasks such as filing paperwork, responding to emails and calls.
- Conducted detailed reviews of denied claims to ensure accuracy of decisions and compliance with regulations.
- Maintained accurate records of all claims activities for audit purposes.
- Followed all company procedures to keep data confidential.
- Gathered proper documentation and data to prepare claims for submission.
- Investigated complex claims by gathering information from various sources to assess validity.
- Managed workload effectively to ensure timely processing of claims within designated deadlines.
- Supported policyholders through the claims process, providing exceptional customer service.
- Maintained confidentiality of claimant information in accordance with privacy laws and regulations.
- Analyzed claims data to determine coverage and liability, ensuring accurate decision-making.
- Reviewed and processed insurance claims following company procedures and industry regulations.
- Participated in claims audit processes to ensure compliance with internal and external standards.
- Communicated with policyholders to explain claims processes, coverage, and decisions.
- Utilized claims processing software to update and maintain accurate claim files.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Input claim information and payments into company database.
- Reduced loss ratios through fair and prompt processing of claims.
- Analyzed claims to determine eligibility and compliance with policy guidelines.
- Reviewed documentation for accuracy and completeness in claims processing.
- Communicated with clients to gather information and clarify claim details.
- Managed claim files and maintained organized records for audits.
- Provided training and support to junior analysts on claims procedures.
- Utilized claims management software to process and track claim statuses efficiently.
STD group Claim Manager
New York Life Insurance Co
New York
10.2015 - 06.2023
- Managed client relationships, ensuring high satisfaction and retention rates.
- Ensured compliance with industry regulations and company policies.
- Resolved customer complaints and issues promptly, maintaining a positive brand image.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Oversaw compliance with regulatory standards and internal policies.
- Enforced customer service standards and resolved customer problems to uphold quality service.
- Coached, mentored and trained team members in order to improve their job performance.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Provided mentorship to junior staff, fostering professional growth and development.
- Enhanced team morale and retention through recognition programs and career development opportunities.
Education
Bachelor of Arts - Marketing
The University of Texas At Arlington
Arlington, TX08-1990
Skills
- Claims processing and investigation
- Regulatory compliance
- Insurance policy knowledge
- Insurance policy coverage expertise
- Medical records review
- Data analysis
- Technical writing
- Administration and Microsoft Excel
- Workflow optimization
- Problem resolution
- Policy interpretation
- Customer relationship management
- Training and mentoring
- Effective communication
- Interpersonal and written communication
- Attention to detail
- Conflict resolution
- Time management
- Multitasking
- Complex Problem-solving
- Teamwork skills
- Computer skills
- Microsoft publisher
Affiliations
Absence Migration Team January 2025 to Present
Work Preference
Job Search Status
Not actively lookingSalary Range
$72000/yr - $200000/yrTimeline
Senior Integrated Claims Analyst
New York Life Insurance Co
06.2023 - Current
STD group Claim Manager
New York Life Insurance Co
10.2015 - 06.2023
Bachelor of Arts - Marketing
The University of Texas At Arlington