Tyler Moore
Blue Island
Summary
Dynamic Medical Claims Analyst with a proven track record at Cigna, excelling in claims analysis and compliance. Expert in utilizing advanced claims management systems and fostering collaboration with healthcare providers. Recognized for enhancing operational efficiency and reducing fraudulent claims through meticulous investigations and strong organizational skills.
Experienced with medical claims analysis, ensuring accuracy and compliance in claim processing. Utilizes analytical skills to identify and resolve billing discrepancies efficiently. Knowledge of healthcare regulations and coding practices to streamline processes and enhance claim accuracy.
Healthcare professional with robust background in medical claims analysis and resolution. Adept at streamlining claim processing workflows and ensuring adherence to industry regulations. Valued team player with focus on collaboration and achieving optimal results, exhibiting flexibility to adapt to evolving demands. Proficient in medical coding, data analysis, and regulatory compliance, showcasing reliability and results-driven mindset.
Overview
15
15
years of professional experience
Work History
Medical Claims Analyst
Cigna
Chicago, IL
06.2023 - 12.2025
- Analyzed medical claims for accuracy and compliance with company policies.
- Collaborated with healthcare providers to resolve claim discrepancies efficiently.
- Reviewed and processed claims using advanced claims management systems.
- Conducted audits on claims to ensure adherence to regulatory standards.
- Reduced fraudulent claims by conducting thorough investigations and collaborating with the fraud detection team.
Disability Benefits Specialist
Metlife
Chicago, IL
01.2022 - 05.2023
- Streamlined benefits enrollment procedures to ensure alignment with company policies and regulatory requirements.
- Analyzed employee benefit needs, providing tailored recommendations to enhance satisfaction and retention.
- Led training sessions for staff on benefits programs, increasing understanding and utilization of available resources.
- Developed comprehensive benefit communication materials to improve employee engagement and awareness.
- Managed benefits enrollment processes to ensure compliance with company policies and regulations.
- Conducted regular audits of benefit programs to identify areas for improvement and ensure accuracy in reporting.
Claims Specialist
Unum
Chicago, IL
10.2021 - 11.2022
- Reviewed and processed claims to ensure compliance with policy guidelines and regulations.
- Collaborated with cross-functional teams to resolve complex claim inquiries and disputes.
- Utilized claims management software to track, update, and analyze claim statuses efficiently.
- Conducted thorough investigations on claims cases, identifying discrepancies and determining eligibility.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
Disability Benefits Specialist
The Hartford
Milwaukee, WI
03.2020 - 12.2020
- Administered employee benefits programs, ensuring compliance with company policies and regulations.
- Collaborated with HR to develop and implement benefits communication strategies for employees.
- Analyzed benefits utilization data to identify trends and recommend improvements to programs.
- Provided guidance to employees regarding benefit options, enhancing understanding and satisfaction.
- Led training sessions for new hires on benefits enrollment processes and available resources.
Disability Claim Coordinator
ABC Insurance Services
Chicago, IL
04.2018 - 09.2019
- Coordinated policy documentation and compliance audits to ensure adherence to regulatory standards.
- Managed client inquiries, providing timely information on coverage options and claims processes.
- Developed training materials for team members, enhancing understanding of insurance products and services.
- Assisted in processing claims, ensuring accuracy and prompt resolution to improve customer satisfaction.
- Conducted comprehensive market research to inform strategic planning, leading to more targeted and effective project initiatives.
- Boosted team morale and productivity by organizing team-building activities and maintaining open-door policy for feedback and concerns.
- Supported marketing initiatives by organizing outreach campaigns targeting potential clients in local communities.
Leave of Absence & Claims Administrator
Sedgwick
Chicago, IL
01.2015 - 12.2017
- Processed and adjudicated claims, ensuring compliance with company policies and regulations.
- Collaborated with internal teams to streamline claims processing workflows and improve efficiency.
- Managed documentation for complex claims, maintaining accurate records and timely updates.
- Trained junior staff on claims procedures, fostering a culture of accuracy and attention to detail.
- Conducted regular audits of claims files to ensure adherence to best practices and regulatory requirements.
- Balanced workload effectively, prioritizing tasks to ensure timely completion of all claim-related responsibilities.
Patient Services Coordinator
Advocate Health Care
Oak Lawn, IL
06.2011 - 03.2014
- Coordinated patient appointments, ensuring optimal scheduling and resource allocation.
- Facilitated communication between patients and healthcare providers, enhancing service delivery.
- Managed patient intake processes, verifying insurance details and medical histories accurately.
- Implemented process improvements that streamlined administrative workflows and reduced wait times.
- Analyzed patient feedback to identify areas for service enhancement, driving quality initiatives.
- Managed sensitive patient data with strict adherence to HIPAA regulations, ensuring privacy and confidentiality at all times.
Education
Western Illinois University
Macomb, IL12-2027
Associate of Science - Computer Science
Northern Illinois University
Dekalb, IL12-2027
Skills
- Multitasking and organization
- Customer service
- Data entry
- Microsoft powerapps
- Microsoft dynamics 365
- Claims analysis
- Microsoft office
- CRM software proficiency
- Cross-selling tactics
- Records management
- Document review
- Workflow coordination
Timeline
Medical Claims Analyst
Cigna
06.2023 - 12.2025
Disability Benefits Specialist
Metlife
01.2022 - 05.2023
Claims Specialist
Unum
10.2021 - 11.2022
Disability Benefits Specialist
The Hartford
03.2020 - 12.2020
Disability Claim Coordinator
ABC Insurance Services
04.2018 - 09.2019
Leave of Absence & Claims Administrator
Sedgwick
01.2015 - 12.2017
Patient Services Coordinator
Advocate Health Care
06.2011 - 03.2014
Western Illinois University
Associate of Science - Computer Science
Northern Illinois University