CALIA BIVENS
Kansas City
Summary
Effective communicator with clients and stakeholders, delivering accurate and timely results in fast-paced environments. Possesses strong analytical, organizational, and customer service skills, ensuring compliance and operational efficiency. Committed to providing exceptional client experiences and fostering positive relationships.
Overview
15
15
years of professional experience
Work History
Life Claims Specialist
Americo Life Insurance
06.2024 - Current
- Conduct thorough review and assessment of life insurance claims to ensure accuracy and adherence to policy terms and regulations.
- Engage with policyholders, beneficiaries, and third-party providers to obtain necessary documentation and address inquiries promptly.
- Utilize medical records, policy details, and other relevant information to determine claim eligibility and calculate payment amounts efficiently.
- Collaborate with underwriting and legal teams to evaluate complex claims and identify and prevent potentially fraudulent activities.
- Maintain meticulous records of claims processing activities and provide detailed reports to management to highlight trends and suggest areas for enhancement.
- Demonstrate strong analytical skills in assessing claim data and making informed decisions to expedite claim processing.
Life Claims Specialist
Kansas City Life Insurance
06.2022 - 05.2024
- Conduct thorough review and assessment of life insurance claims to ensure accuracy and adherence to policy terms and regulations.
- Engage with policyholders, beneficiaries, and third-party providers to obtain necessary documentation and address inquiries promptly.
- Utilize medical records, policy details, and other relevant information to determine claim eligibility and calculate payment amounts efficiently.
- Collaborate with underwriting and legal teams to evaluate complex claims and identify and prevent potentially fraudulent activities.
- Maintain meticulous records of claims processing activities and provide detailed reports to management to highlight trends and suggest areas for enhancement.
- Demonstrate strong analytical skills in assessing claim data and making informed decisions to expedite claim processing.
Medical/Dental Claims and Billing Specialist
GEHA
03.2019 - 06.2022
- Process and submit insurance claims for patients daily, ensuring accurate coding and adherence to payer guidelines.
- Review patient charts and documentation to verify coding accuracy and compliance.
- Follow up on unpaid claims and resolve discrepancies with insurance companies and patients.
- Conduct audits of billing records to identify and correct errors, reducing claim denials.
- Collaborate with healthcare providers and administrative staff to ensure timely and accurate billing processes.
Accounts Billing and Disputes
Alliance Data
03.2014 - 02.2019
- Investigated and resolved billing disputes in a timely manner to ensure accurate invoicing.
- Communicated effectively with clients to address billing inquiries and provide satisfactory resolutions.
- Implemented strategies to reduce billing errors and improve overall billing accuracy.
- Managed a system for tracking and following up on outstanding invoices to expedite payment.
- Collaborated with internal teams to streamline billing processes and enhance efficiency.
- Ensured compliance with company policies and procedures regarding billing and invoicing practices.
E Finance
04.2011 - 01.2014
- Managed collections process, including contacting customers for outstanding payments and resolving payment discrepancies.
- Utilized financial software to track and analyze accounts receivable and accounts payable data.
- Prepared detailed cash flow forecasts to support financial decision-making.
- Collaborated with cross-functional teams to streamline financial processes and improve efficiency.
- Conducted regular audits to ensure compliance with financial regulations and internal policies.
Education
Some College (No Degree) -
Metropolitan Community College
Kansas City, MOSkills
- Claims assessment
- Fraud detection
- Medical records analysis
- Policy interpretation
- Claims processing software
- Insurance regulations
- Policy analysis
- Customer relationship management
- Billing accuracy
- Documentation review
- Problem solving
- Effective communication
- Attention to detail
- Conflict resolution
- Time management
- Analytical thinking
- Strong lead development skills
- Relationship building
- Accounts payable/receivable
- Team Training
Timeline
Life Claims Specialist
Americo Life Insurance
06.2024 - Current
Life Claims Specialist
Kansas City Life Insurance
06.2022 - 05.2024
Medical/Dental Claims and Billing Specialist
GEHA
03.2019 - 06.2022
Accounts Billing and Disputes
Alliance Data
03.2014 - 02.2019
E Finance
04.2011 - 01.2014
Some College (No Degree) -
Metropolitan Community College