Yvette Chuba Email & Phone Number

Plymouth, MN

Review and adjudicate claims in accordance with claim processing guidelines set by the department. Communicate with internal and external customers to validate claim eligibility. Apply medical necessity, eligibility guidelines to ensure all cost containment measures are met to complete the claim adjudication process. Identify and report claim overpayment.

Plymouth, Minnesota

• Provided support and assistance to the Legal Department and Operations for state market conduct exams for a variety of compliance issues.
• Validated, assembled, and quality reviewed market conduct files to ensure legal and regulatory compliance.
• Validation of Compliance reports. Collaborated within the team to identify process improvements to facilitate project completion for Operational areas.

Plymouth, MN

• Provide quality related monitoring and evaluation services through pinpointing behaviors and responsible for auditing, cross-departmental facilitation and process improvements.
• Audited work product performed by Processors to ensure accuracy
• Performed system processing audits using process excellence guidelines and monitoring tools
• Provided performance feedback on audit results
• Captured trends in audits to identify learning opportunities
• Recommended enhancements to training program based on risk identification outcomes

Plymouth, MN

• Processed claims for all lines business on multiple processing systems while consistently exceeding department standards for quality and production
• Applied established workflow, process and procedure to adjudicate claims within established metrics
• Achieved outstanding quality and quantity outcomes that contributed to overall team success for claims processing goals and objectives for the division
• Attended training to keep abreast of regulatory and policy changes to benefits and procedures