Renae Coleman
Gastonia
Summary
Adaptable professional with a strong foundation in training and appeals analysis. Recognized for exceptional communication skills and critical thinking, dedicated to fostering teamwork and enhancing organizational outcomes.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Training Deployment
Aetna
02.2022 - Current
- Accountable for initial onboarding and job specific training for new colleagues.
- Design, deliver, and maintain department curriculum.
- Independently oversee virtual classroom environment, managing all aspects of student engagement and learning retention.
- Collaborate with leadership to ensure successful development and delivery of training materials.
- Actively engage with other training staff and subject matter experts to collaborate and influence the design and development of curriculum, while using the appropriate learning medium.
- Manage participant performance in the classroom, to ensure adherence to Aetna standards and policies; provide feedback to management as appropriate.
- Collect and share curriculum and training feedback from participants to enhance curriculum and training based on that feedback.
Sr. Complaint & Appeals Analyst
Aetna
01.2018 - 02.2022
- Review and translate organizational policies into written responses to provider and member appeals based on regulations and legislation, employing all tools associated with claims and appeals processing.
- Make decisions based upon current policies/guidelines to ensure business continuity with awareness of all possible implications and impact.
- Manage inventories and workflows to ensure regulatory requirements are met.
- Document and track appeal intakes, outcomes, trends, and workflows, identifying areas in need of improvement.
- Work collaboratively across the organization both internally and externally.
- Coach and support others with accuracy and ethical resolution.
Sr. Claim Benefit Specialist
Aetna
01.2013 - 01.2018
- Review, process, and complete various types of claims, including medical and hospital claims.
- Verify claim information, assess eligibility, determine benefits, and ensure accurate and timely processing, while effectively facilitating cost containment measures to assist in the claim adjudication process.
- Ensure compliance with relevant laws, regulations, and industry standards related to claims processing.
- Organize and conduct training for junior staff to help navigate complex claim scenarios, sharing knowledge and expertise to ensure a proficient and cohesive team.
- Identify claim cost management opportunities and refers recommendations to managers.
Education
Associate of Applied Science - Office Systems Technology
Gaston College
Dallas, NCAssociate of Applied Science - Medical Office Administration
Gaston College
Dallas, NCSkills
- Time management
- Problem-solving
- Flexible and adaptable
- Excellent verbal and written communication
- Teamwork and collaboration
- Critical thinking
- ACAS/RUMBA
- ECHS
- MedCompass
Certification
- Aetna Certified Writer
- Health Insurance Associate (HIAA)
Timeline
Training Deployment
Aetna
02.2022 - Current
Sr. Complaint & Appeals Analyst
Aetna
01.2018 - 02.2022
Sr. Claim Benefit Specialist
Aetna
01.2013 - 01.2018
Associate of Applied Science - Office Systems Technology
Gaston College
Associate of Applied Science - Medical Office Administration
Gaston College