Kelly Kniat
Tunnel Hill
Summary
Offering background in key skills such as effective communication and problem-solving, eager to learn and develop in this environment. Contributes proactive approach and willingness to adapt. Ready to use and develop customer service and conflict resolution skills in Complex Claims Specialist role.
Overview
25
25
years of professional experience
Work History
Claims Lead Representative
First Source
01.2024 - Current
- Identified process inefficiencies within department workflows, resulting in streamlined practices that saved time and resources.
- Ensured compliance with industry regulations by following policies and procedures across the organization.
- Developed and maintained positive relations with service partners and coordinated with team members to properly handle requests and questions.
- Responded to Healthcare Provider appeals via written correspondence regarding claim allowances and code edit denials.
- Enhanced client satisfaction by addressing and resolving complex issues promptly and professionally.
Claims Lead Representative
Cigna
01.2007 - 12.2024
- Identified process inefficiencies within department workflows, resulting in streamlined practices that saved time and resources.
- Ensured compliance with industry regulations by following policies and procedures across the organization.
- Developed and maintained positive relations with service partners and coordinated with team members to properly handle requests and questions.
- Responded to Healthcare Provider appeals via written correspondence regarding claim allowances and code edit denials.
- Enhanced client satisfaction by addressing and resolving complex issues promptly and professionally.
Plan Automation Analyst
Cigna
04.2004 - 01.2007
- Designed custom scripts and macros to enhance the functionality of automation tools, tailoring plan setups to meet specific benefit requirements as requested by the account.
- Managed account implementation timelines and resources effectively, consistently delivering high-quality results within tight timeframes.
- Ensured compliance with state and federal laws during all stages of plan automation and benefit execution.
- Partnered with other member of the implementation team for automation projects, ensuring compatibility with existing systems and optimal results.
Customer Service Representative
Cigna
02.2000 - 04.2004
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Responded to customer and provider requests for benefit and claim information.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
Education
Associate of Applied Science - Medical Office Administration
Dalton State College
Dalton, GA05-2002
Skills
- Proficient in OneView and PrePricing Network
- Previous experience with Proclaim
- Written communication
- Operational efficiency
- Adaptability and flexibility
- Excellent communication
- Multitasking Abilities
- Reliability
Timeline
Claims Lead Representative
First Source
01.2024 - Current
Claims Lead Representative
Cigna
01.2007 - 12.2024
Plan Automation Analyst
Cigna
04.2004 - 01.2007
Customer Service Representative
Cigna
02.2000 - 04.2004
Associate of Applied Science - Medical Office Administration
Dalton State College
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