Summary
Overview
Work History
Skills
Timeline
Generic

Chelsi Corriveau

Ashley,PA

Summary

Highly motivated and detail-oriented Claims Specialist with over seven years of experience in evaluating, negotiating, and resolving complex insurance claims. Proven ability to assess damages accurately, interpret regulatory requirements, and deliver timely and fair claim settlements. Strong communication, documentation, and problem-solving skills. Seeking to leverage transferable expertise in a new industry or role where investigation, compliance, and customer service are key components.

Overview

9
9
years of professional experience

Work History

Claims Representative (Contract Position)

Corvel
07.2024 - Current
  • Conduct comprehensive investigations, reviewing medical records and statements to assess compensability.
  • Identified inconsistencies or fraudulent activity and coordinated findings with legal counsel.
  • Assisted in processing insurance claims, ensuring compliance with company policies and regulations.
  • Learned to evaluate claim validity through thorough investigation and documentation review.
  • Ensure timely and compliant claim payments per state guidelines.
  • Maintain accurate, detailed claim records in internal systems.

Senior Resolutions Manager

Gallagher Bassett
04.2022 - 07.2024
  • Led high-volume claim investigations across multiple jurisdictions.
  • Partnered with defense attorneys to resolve complex and litigated claims efficiently.
  • Delivered detailed reporting to internal and external stakeholders.
  • Resolved complex customer issues by implementing effective troubleshooting strategies and best practices.
  • Collaborated with cross-functional teams to enhance service delivery and improve resolution processes.
  • Maintained regulatory compliance and met aggressive resolution timelines.

Senior Claims Representative

Sedgwick
01.2021 - 04.2022
  • Managed workers' compensation and liability claims, ensuring accuracy and fairness.
  • Reviewed documentation for discrepancies and resolved conflicts with claimants and counsel.
  • Worked cross-functionally to improve process flow and reduce claim cycle time.
  • Managed complex claims processes, ensuring compliance with regulatory requirements and company policies.
  • Led cross-functional teams to streamline claims handling procedures, enhancing operational efficiency.
  • Analyzed claim data to identify trends, recommending adjustments to improve service delivery and accuracy.
  • Mentored junior representatives, providing guidance on best practices for claims assessment and resolution.

Claims Adjuster

Berkshire Hathaway GUARD Insurance
04.2018 - 01.2021
  • Investigated, evaluated, and settled insurance claims with adherence to company and legal standards.
  • Handled medical records, billing, and claimant communication with professionalism and accuracy.
  • Evaluated and processed insurance claims to ensure compliance with policy terms and regulations.
  • Collaborated with policyholders, medical providers, and legal professionals to gather necessary documentation.
  • Investigated complex claims by analyzing evidence and interviewing involved parties to determine validity.

Assistant Manager

Turkey Hill Minute Markets
11.2017 - 11.2018
  • Supervised retail team, coordinated schedules, and conducted performance evaluations.
  • Handled customer service, conflict resolution, and inventory management.
  • Trained new employees on policies, procedures, and sales goals.
  • Conducted interviews, hiring, and termination of employees.
  • Supervised daily operations to ensure adherence to company policies and procedures.
  • Developed training programs for new staff to enhance team performance and efficiency.
  • Close communication with senior management regarding updates/compliance with company policy.
  • Implemented process improvements that streamlined workflow and reduced operational bottlenecks.
  • Managed inventory control systems, ensuring optimal stock levels and accuracy in reporting.

Office & Practice Manager

Insight Counseling & Psychotherapy
11.2016 - 04.2018
  • Managed daily operations of a mental health practice, including patient intake, scheduling, and billing.
  • Handled insurance verification and payment tracking in compliance with HIPAA.
  • Counseled patients on insurance requirements and financial responsibility.
  • Oversaw daily operations, ensuring compliance with healthcare regulations and standards.
  • Developed and implemented efficient scheduling processes to optimize staff utilization.
  • Managed patient flow, reducing wait times through strategic resource allocation.
  • Enhanced billing processes, improving accuracy and reducing discrepancies in financial reporting.
  • Marketed services to local healthcare providers and community networks.

Skills

  • Claims analysis expertise
  • Medical Documentation Review
  • Insurance Regulations & Compliance
  • Fraud analysis and mitigation
  • Project Coordination
  • Effective communication with clients and stakeholders
  • Microsoft Office Suite
  • EMR & Electronic Billing Systems
  • Process Improvement
  • Team Collaboration
  • Insurance claims review
  • Claims investigation
  • Organizational time strategies

Timeline

Claims Representative (Contract Position)

Corvel
07.2024 - Current

Senior Resolutions Manager

Gallagher Bassett
04.2022 - 07.2024

Senior Claims Representative

Sedgwick
01.2021 - 04.2022

Claims Adjuster

Berkshire Hathaway GUARD Insurance
04.2018 - 01.2021

Assistant Manager

Turkey Hill Minute Markets
11.2017 - 11.2018

Office & Practice Manager

Insight Counseling & Psychotherapy
11.2016 - 04.2018

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Chelsi Corriveau