Amber Robinson
Alexander
Work History
Claims Sr. Representative
Cigna
08.2022 - Current
- Detail-oriented Medical Claims Reviewer/Analyst with over 3 years of experience in evaluating, processing, and adjudicating medical claims.
- Proficient in medical coding (ICD-10, CPT, HCPCS), claims processing systems, and healthcare regulations, including HIPAA and Medicare/Medicaid guidelines.
- Adept at identifying billing discrepancies, ensuring compliance, and collaborating with providers and insurance companies to resolve claim disputes efficiently.
- Strong analytical skills with a commitment to accuracy and timely claims resolution.
Claims Analyst
Aston Carter
12.2021 - 08.2022
- Detail-oriented and efficient Claims Analyst with experience in medical claims processing, error resolution, and healthcare regulatory compliance.
- Skilled in analyzing and adjudicating claims using HealthRules (HRP), EXP/Macess, and SharePoint systems.
- Proven ability to maintain 98% accuracy in claims processing while ensuring compliance with Medicare, Medicaid, and private insurance policies.
- Adept at identifying and resolving claim exceptions, improving workflow efficiency, and collaborating across departments for seamless claim resolution.
- Strong technical proficiency with CPT, ICD-10, HCFA, and Microsoft Office Suite.
Claim Benefits Specialist
Aetna, a CVS Health
08.2021 - 03.2022
- Knowledge in Medicare claims adjudication, eligibility verification, and compliance with CMS and Aetna guidelines.
- Skilled in processing and analyzing claims in HealthRules (HRP) and Electronic Correspondence Handling System (ECHS) while maintaining accuracy and efficiency.
- Experienced in applying medical necessity guidelines, cost containment measures, and coding protocols (CPT, ICD-10, HCFA).
- Strong ability to identify discrepancies, resolve claim exceptions, and ensure compliance with regulatory standards.
- Proven track record of meeting/exceeding production and quality benchmarks, with experience in training team members on claims processing best practices.
Associate Benefits Claim Specialist
Aetna, a CVS Health
10.2019 - 09.2021
- Efficient Claims Analyst with expertise in processing paper and electronic claims, adjustments, and work queues in compliance with company policies and Medicare regulations.
- Proficient in reviewing pended claims, verifying authorizations, payments, denials, and coordination of benefits while ensuring accuracy and compliance.
- Strong analytical skills with a track record of maintaining production and quality standards in a fast-paced environment.
- Adept at researching and resolving claim discrepancies, documenting processes, and demonstrating professionalism in customer interactions.
- Committed to continuous self-development and contributing to team success.
Health Information Associate (HIM)
Memorial Hermann Hospital
01.2016 - 10.2019
- Health Information Management (HIM) professional with expertise in medical record retrieval, scanning, indexing, and quality control.
- Skilled in maintaining electronic and hybrid medical records, ensuring accuracy, compliance, and efficient document management.
- Experienced in verifying, compiling, and organizing patient records while adhering to HIPAA and healthcare facility policies.
- Adept at maintaining high productivity and quality in a fast-paced environment, with a commitment to accuracy, organization, and adherence to industry standards.
Education
Some College (No Degree) - Fine Arts
Skills
- Databases
- Health care systems
- Health information management
- Adaptability in fast-paced environments
- HealthRules® Payer
- Medical Claims Review and Adjudication
- CPT, ICD-10, and HCPCS coding, Medicare, Medicaid, and commercial insurance policies
- Claims Processing Systems (eg, Epic, Facets)
- Fraud Detection & Compliance Auditing
Data Analysis & Reporting - Medical Claims Processing & Adjudication
- CPT, ICD-10, HCFA Coding & Compliance
- EXP/Macess Software
- Regulatory Compliance & Quality Control
- Data Analysis, Research & Problem-Solving
- Workflow Management & Process Improvement
- Microsoft Office (Excel, Outlook, SharePoint)
Timeline
Claims Sr. Representative - Cigna
08.2022 - Current
Claims Analyst - Aston Carter
12.2021 - 08.2022
Claim Benefits Specialist - Aetna, a CVS Health
08.2021 - 03.2022
Associate Benefits Claim Specialist - Aetna, a CVS Health
10.2019 - 09.2021
Health Information Associate (HIM) - Memorial Hermann Hospital
01.2016 - 10.2019
University of Arkansas At Little Rock - Some College (No Degree), Fine Arts
Summary
With over three years of experience in the health insurance industry, I am a Claims Sr. Representative at Cigna, one of the leading global health service companies. I process multifaceted medical claims for healthcare providers and policy holders, ensuring accuracy, timeliness, and confidentiality. I have demonstrated history of researching and processing institutional, professional, dental, and vision Medicare claims, using my knowledge of medical terminology, diagnosis, and CPT codes. I am skilled in databases, health care systems, Medicare, and health information management. I can work in a fast-paced environment and adapt to change. My goal is to help our customers maintain their health, well-being, and sense of security. Help our customers maintain their health, well-being and sense of security by ensuring multifaceted medical claims are processed accurately and timely for healthcare providers and policy holders while protecting the confidentiality of our customer's personal health information.
Goals
Help customers maintain their health, well-being, and sense of security.
Overview
9
9
years of professional experience
Similar Profiles
Diahanna BridgesDiahanna Bridges
Customer Service Representative at CignaCustomer Service Representative at Cigna
Jennifer SmithJennifer Smith
Eligibility Representative – Specialty Pharmacy Division at CignaEligibility Representative – Specialty Pharmacy Division at Cigna
Rudee FriarRudee Friar
Customer Service Representative at CignaCustomer Service Representative at Cigna
Lavakumar ReddyLavakumar Reddy
SENIOR SERVICENOW SME at CignaSENIOR SERVICENOW SME at Cigna
Tristen GentryTristen Gentry
Appeals Proofreader and Distribution Specialist at Allegiance Benefit Plan ManagementAppeals Proofreader and Distribution Specialist at Allegiance Benefit Plan Management