Summary
Overview
Work History
Education
Skills
Skills
Timeline
Generic

Casey Vue

Andover,MN

Summary

I am currently a Business Analyst in the FWAE (Fraud, Waste, Abuse, Error) Post Pay department, where I oversee reporting, claim selections, and claims integrity, manage ad hoc projects, and provide comprehensive support and expertise to the teams and leadership.

I hold over 11 years of experience in the health insurance industry, spanning call center operations, credentialing, investigations, and analytics. Within this, I have 7 years of experience in the claims investigations space — including 3 years in a purely dedicated analytical role and 5 years in an analytical investigations role.

I have experience working with a variety of provider types across multiple roles and possess knowledge of several claim platforms within the organization, including Facets, Unet, Cosmos, and Cirrus.

Overview

13
13
years of professional experience

Work History

Business Analyst

Optum
09.2022 - Current
  • Oversee claim selections for the Post Pay FWAE division
  • Maintain integrity of claims, outcomes, outstanding audits
  • Provide analytical support and expertise to department leaders
  • Assisting/leading various ad hoc audit projects
  • Collaboration with internal business partners and UHC

Recovery/Resolution Analyst

Optum
10.2018 - 09.2022
  • Claims investigations within the Post Pay FWAE space
  • Manage portfolio of approximately 150 + cases per month for auditing
  • Various claim platforms utilization
  • Training of new hires
  • Active member on PNP committee

Credentialing Coordinator

Optum
07.2017 - 10.2018
  • Initial credentialing of providers for the Optum Behavioral Health Network
  • Primary source verification of education, board certification, licensure, and sanctions
  • Auditing of internal provider files for completeness and accuracy.


Credentialing Specialist

Amplifon Hearing Health Care
04.2015 - 07.2017
  • Initial and re-credentialing of network providers
  • Assisted with managed care auditing processes and performed internal file audits.
  • Maintained NCQA accreditation
  • Relationship building with network providers

Patient Care Advocate Lead

Amplifon Hearing Health Care
08.2014 - 04.2015
  • Lead and support for 4 team members, conducted monthly 1:1s and performance reviews in conjunction with Patient Care Supervisor
  • First contact for national payor groups with regards to patient insurance issues
  • High volume call center handling and resolution specialist for escalated calls
  • Resolved problems with areas such as communication and billing that could negatively impact patient care

Collections Representative

Diversified Adjustment Services
07.2012 - 05.2014
  • Account reconciliation for national groups in alignment with FDCPA laws
  • Proven success in handling large medical accounts
  • Negotiated to collect balance in full.
  • Negotiated re-payment plans by identifying causes of delinquent payments to assist in recovery of debt and meet realistic timeframes.

Education

High School Diploma -

Coon Rapids Sr. High

Skills

  • Investigative claims analysis
  • Claims processing systems
  • Network provider credentialing
  • NCQA accreditation expertise
  • PNP community
  • Process flow development
  • Employee training
  • Excel data analysis skills

Skills

  • Claim Platforms
  • Tableau
  • Excel

Timeline

Business Analyst

Optum
09.2022 - Current

Recovery/Resolution Analyst

Optum
10.2018 - 09.2022

Credentialing Coordinator

Optum
07.2017 - 10.2018

Credentialing Specialist

Amplifon Hearing Health Care
04.2015 - 07.2017

Patient Care Advocate Lead

Amplifon Hearing Health Care
08.2014 - 04.2015

Collections Representative

Diversified Adjustment Services
07.2012 - 05.2014

High School Diploma -

Coon Rapids Sr. High

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Casey Vue