Jennifer Zanzie
Loves Park
Summary
I have Excellent skills compiling, coding, categorizing and auditing information to process claims. Claims examiner with over 5 years of experience.
Strong communication, conflict resolution and negotiation skills combined with excellent reporting and research skills.
Thorough understanding of how claims process and over 2 years of Fraud experience. I have solid abilities in developing, compiling, coding, categorizing and auditing information to process different types of claims.
Willingness to take on added responsibilities to meet team goals. Hardworking and very passionate job seeker with strong, detailed oriented team player with multi-tasking simultaneously with a high degree of accuracy.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Claims Examiner
Alight Solutions LLC
07.2023 - Current
- Take inbound customer calls for a variety of reasons
- Answer customer questions regarding premiums and co-pays related to their coverage
- Go over every plan that is available and answer questions regarding specific procedures that need authorization
- Take calls regarding premium payment issues and questions regarding end of coverage letters
- Assist customers with mobile phone set up
- Assist customers with registration for website
- Assist customers with all medical, dental and vision plans that were available in their area
- Explain premiums, co-pays, deductibles and out of pocket maximums related to each plan.
Unemployment Claims Examiner
State of New Jersey- Department of Community Affairs
02.2022 - 06.2023
- Tracked fraud cases and monitored trends to develop strategies for prevention.
- Provided support for colleagues regarding Claim denials
- Took customer calls, regarding questions relating to program eligibility and required Documents Needed for application/ gave Deadlines for applications
- Assisted with Back-End Processing for thousands of claims for approved applicants
- Completed Spreadsheets for Tracking Purposes and conduct customized
- Streamlined investigative processes with technology integration and data analytics tools, increasing productivity and accuracy.
- Had conference calls with the State Of New Jersey Executives, project managers regarding, process changes/New Program Details/deadlines.
- Developed strong relationships with internal and external stakeholders, fostering open communication and collaboration.
- Collaborated with insurance adjusters to expedite claim settlements, ensuring fair resolutions for all parties involved.
- Researched claims and incident information to deliver solutions and resolve problems.
- Maintained contact with claimants and attorneys to determine treatment status.
- Interviewed claimants and witnesses to gather factual information.
- Conducted thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
Unemployment Claims Specialist
New York Department Of Labor
01.2021 - 01.2022
- Provided support for the state of New York
- Completed Unemployment claims for clients claiming Pandemic (COVID-19) unemployment compensation benefits
- Assisted the Fraud department, constant multi-tasking, going through identity documents to un-freeze accounts
- Push weekly claims through, assisted with Online account issues such as, password resets and account creations
- Educated customers on Self-Service tools
- Explained benefits in detail, gave expiration dates for programs, Assisted customers with Reactivation and all documented each call
- This position was informative, it gave me the insight on the big picture of what it takes to ensure that New Yorkers are receiving Unemployment compensations when needed the most
- Communicated with people from various cultures and backgrounds on application process
- Inputted all gathered information and researched data on applicants into computer system using various systems
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
Unemployment Claims Specialist/Analyst
Everise
03.2020 - 01.2021
- Supported Customer Service Representatives with inbound Claimant calls regarding Unemployment benefits
- With this role being very task oriented, it was important to stay focused, patient, have de-escalation skills and empathy
- Due to COVID-19 workloads were impacted and millions of claimants were filling for unemployment benefits
- Many Claimants never filed for benefits prior COVID-19 and many Applicants were scared and I reflected back on my previous experience
- Empathy, understanding, Education
- Processed Claims for all lines of business, PEUC, PUA and EB it was very important to stay up to date regarding program eligibility
- Communicated with people from various cultures and backgrounds on application process
- Followed Federal guidelines when reviewing applicant data to determine Unemployment eligibility for UI, EB, PEUC, PUA benefits
- Documented all communication with applicants and inputted information into system database.
IT Technician, Carrier/Contractor
Schneider National
03.2019 - 12.2019
- Assisted with the programming and the entire set up process for both driver and internal systems
- Sent updates through several internal outlets for new mandates
- Installation of over 25,000 new Samsung Tablets, starting with the East Coast
- All drivers, including long-haul, short-haul, dedicated, Schneider contract drivers and all rail drivers needed to receive new tables.
Caregiver
PCW
01.2016 - 12.2019
- Assisted both Medical and Mental help for two clients
- Assisted them with daily needs such as transportation to various appointments, house cleaning, hygiene, cooking, and medical requirements.
Caregiver
PCW
01.2014 - 12.2015
- Assisted with all daily activities, including cooking, cleaning, transportation, and medical requirements.
Medical Claims Representative
United Healthcare Insurance Company
01.2013 - 11.2013
- Provided support for both Fully insured and Self-Funded Insurance Plans
- Main responsibility was Medical claims processing, Verification of plan benefits
- Working with Provider Networks and Contractual Rates for services provided both In-Network and Out-of-Network.
Medical Claims Specialist
Humana Insurance Company
01.2007 - 01.2013
- Primarily responsible for all Self-Funded Medical, Dental and Pharmaceutical Claims processing using the Availity System
- Worked with providers and USAA in making sure that all contracted rates were finalized
- Worked with leads, supervisors, and managers to make sure that all procedures were followed.
Operations Customer Service Specialist
Schneider National Carriers, Inc
07.2005 - 01.2007
- Tracked freight, scheduled pickups and deliveries, created cost-effective ways for the company to move their freight
- Responded proactively and positively to rapid change
- Exhibited high energy and professionalism when dealing with all levels of clients and staff.
Front Desk and Optical Center Specialist
Photo Lab
06.2002 - 07.2005
- Daily maintenance on the Photo machine and other Photo Lab equipment
- Developed rolls of 35MM film and digital photos
- Sold and demonstrated digital cameras
- Assisted customers with using self-service machines and explained available services.
Front Desk and Portrait Studio Specialist
Photo Lab
06.2002 - 07.2005
- Took professional pictures in the studio, cross-sold products, and scheduled pickup appointments
- Presented specialty items to customers and provided excellent customer service.
Education
Associate of Science - Business
Rasmussen College
Green Bay, WIHigh school diploma - General Studies
Bay Port High School
Green Bay, WISkills
- Effective communication skills
- Good listening skills
- Computer skills
- Good telephone etiquette
- Responsible
- Claim Form Analysis
- Effective communication skills
- Good listening skills
- Computer skills
- Good telephone etiquette
- Responsible
- Claim Form Analysis
- Microsoft Office Suite
- Claims adjustment
- Fraudulent Claims Investigation
- Disability claims process
- Client Interviewing
- Records Review
- Microsoft Office Suite
- Claims adjustment
- Fraudulent Claims Investigation
- Disability claims process
- Client Interviewing
- Records Review
Certification
Medical Billing and Claims Coding (MB&CC)
Additional Information
Authorized to work in the US for any employer
Timeline
Claims Examiner
Alight Solutions LLC
07.2023 - Current
Unemployment Claims Examiner
State of New Jersey- Department of Community Affairs
02.2022 - 06.2023
Unemployment Claims Specialist
New York Department Of Labor
01.2021 - 01.2022
Unemployment Claims Specialist/Analyst
Everise
03.2020 - 01.2021
IT Technician, Carrier/Contractor
Schneider National
03.2019 - 12.2019
Caregiver
PCW
01.2016 - 12.2019
Caregiver
PCW
01.2014 - 12.2015
Medical Claims Representative
United Healthcare Insurance Company
01.2013 - 11.2013
Medical Claims Specialist
Humana Insurance Company
01.2007 - 01.2013
Operations Customer Service Specialist
Schneider National Carriers, Inc
07.2005 - 01.2007
Front Desk and Optical Center Specialist
Photo Lab
06.2002 - 07.2005
Front Desk and Portrait Studio Specialist
Photo Lab
06.2002 - 07.2005
Associate of Science - Business
Rasmussen College
High school diploma - General Studies
Bay Port High School