Allison Horn
Cave City
Summary
Detail-oriented professional with expertise in claims processing and fraud detection. Proven ability to identify trends and support investigations, enhancing compliance and operational efficiency.
Adaptable and proactive investigator with strong skills in case management and communication. Successfully advocated for members and resolved billing issues, contributing to improved member satisfaction and compliance with regulatory standards.
Overview
3
3
years of professional experience
Work History
SIU Investigator
UMR
Remote
08.2025 - Current
- Identify emerging trends & fraud risk
- Monitor claims, billing patterns & emerging trends for potential fraud risks
- Support investigations , flagging providers & payment prevention efforts
- Communicate findings, trends to leadership
Complex Case Manager
UMR
Remote
07.2023 - 07.2026
- Documented ongoing cases and confirmed compliance with regulatory standards and accuracy.
- Advocated for the member to resolve their issue
- Worked with Providers on behalf of the members to resolve any billing issues
Education
High School Diploma -
Vidor High
Vidor, TXSkills
- Experience with claims processing, quality review & Jacada & Wauben systems
- Familiar with Knowledge Library and UMR Policies and Procedures
- Experience with Fraud, Waste, and Abuse
- Currently in courses for CPC Certification will be certified by 1-2027
- Not claims trained but would be willing to learn and would love to learn the process
- Love the constant change and learning, continue to grow
Timeline
SIU Investigator
UMR
08.2025 - Current
Complex Case Manager
UMR
07.2023 - 07.2026
High School Diploma -
Vidor High