ANTHEM BLUECROSS / BLUESHIELD, South Portland, ME 1998 - 2020High Dollar Claims AuditorReviewed claim receipts encompassing keying, coding, member eligibility and contract, provider agreements, state, federal, and company guidelines. Provided knowledge of coverage in multiple states for specific statutes and various types, including HMO / PPO / EPO. • Conducted claims investigation, ensuring proper billing practices from contracted and non-contracted providers for correct reimbursement based on contracts, laws, and pricing guidelines, achieving finalized rate +100% every year. • Examined for eligibility, timeliness, financial accuracy, denial accuracy, providing accurate feedback to processors / examiners and claims management, discovering any training issues or system updates needing correction; • Reported audit results and error trends, fostering team environment for any solutions needed, enabling department goals to be met, and discovering more document update requirements than other team members, pinpointing ~2 per month. • Processed on multi-state and multi-plan types for claim payments, showing knowledge of different state requirements, so coverage, as needed, was available, utilizing for numerous projects. • Analyzed more complex claims, including transplant and stop-loss per special provider contracts, ensuring adherence for provider satisfaction and proper payment and less rework. • Required more in-depth knowledge; 1 of only 8 trained. • Collaborated with various functional areas for issues due to knowledge of how multiple functions interfaced together •Worked in progress system changes, visualizing objectives, and completing earlier than projected • Discovered $1B+ in savings yearly while exceeding department production and quality goals when validating claims prior to release by spotting incorrect coverage, benefit application, other insurance coverage, contract limitations, and industry payment standards.