Dawn Gillman Email & Phone Number

Des Moines, Iowa, United States

Perform audits of core business processes, including claims payment, member benefits and enrollment, customer service inquiries and provider contracts. Applying knowledge, skill and experience over a broad range of financially and operational significant corporate operations and relates business transaction processing functions.

Des Moines, Iowa, United States

 Coordinate the implementation and quality assurance of benefit logic for automated claims adjudication. Analyze complex and customized benefit designs to ensure coding accuracy. Conduct benefit quality reviews for standard and basic plan designs. Communicate between benefit design and quality to ensure proper claims processing.

Des Moines Metropolitan Area

 Reviewed and completed enrollment documents, OBS benefit designs, benefit configuration (coding), claims processing, and customer inquiries. Performed Facets and Model Office testing, retesting, and reviews in a test environment, including for Remediation. Documented benefit configuration testing results. Created test plans and scenarios for Model Office demonstrating both negative and positive impacts. Developed Business Objects reports and other customized reports to capture accurate claims scenarios.> Contributed to high customer satisfaction and membership growth/retention by consistently meeting or exceeding production, accuracy, and timeliness standards.

Des Moines, Iowa

 Processed medical, hospital, and vision claims and adjustments, utilizing knowledge of CPT and ICD-9. Responded to complex questions and performed research to ensure proper payment member satisfaction.> Served as Subject Matter Expert for new employees and coached/mentored Benefit Coding Analysts.> Consistently exceeded production and quality goals and was promoted to Claims Examiner III in 2015.

 Prepared legal documentation, including Summary Plan Descriptions and Administration documents. Researched complex issues and provided excellent customer service to members and groups. Maintained and updated changes in enrolment and renewal information.> Contributed to paperless faxing project, enabling the company to save money and streamline the process.

 Reported on claim adjudications and flexible benefits.> Exceeded production standards for claims processed per hour.> Piloted a project to create a customer service function that enabled the flexible Benefit department to enhance the customer experience and leverage staff more efficiently.

 Processed life insurance claims with quick turnaround time, exceeding member satisfaction.> Devised new procedures to meet the needs of a top tier client.> Trained new employees on complex processes, including high dollar claims and claim audits.

Bachelor Of Arts, Organizational Management

Activities and Societies: Summa Cum Laude, Member of Alpha Lambda Chapter of Alpha Sigma Lambda National Honor Society for Adult Students.

Business Management

Nursing

Business Administration