close
  • Dashboard
  • Resumes
  • Cover Letters
  • Resumes
    • Resumes
    • Resume Builder
    • Resume Examples
      • Resume Examples
      • Nursing
      • Customer Service
      • Education
      • Sales
      • Manager
      • View All
    • Resume Search
    • Resume Templates
      • Resume Templates
      • Microsoft Word
      • Professional
      • Modern
      • Traditional
      • Creative
      • View All
    • Resume Services
    • Resume Formats
      • Resume Formats
      • Chronological
      • Functional
      • Combination
    • Resume Review
    • How to Write a Resume
      • How to Write a Resume
      • Summary
      • Experience
      • Education
      • Skills
        • Skills
        • Hard Skills
        • Soft Skills
    • Resume Objectives
  • CV
    • CV
    • CV Examples
    • CV Formats
    • CV Templates
    • How to Write a CV
  • Cover Letters
    • Cover Letters
    • Cover Letter Builder
    • Cover Letter Examples
      • Cover Letter Examples
      • Customer Service
      • Marketing
      • Sales
      • Education
      • Accounting
      • View All
    • Cover Letter Services
    • Cover Letter Templates
    • Cover Letter Formats
    • How to Write a Cover Letter
  • Questions
  • Resources
  • About
    • About
    • Reviews
  • Contact
  • jane
    • Settings
    • Help & Support
    • Sign Out
  • Sign In
Member Login
  • LiveCareer
  • Resume Search
  • Appeals Manager
Please provide a type of job or location to search!
SEARCH

Appeals Manager Resume Example

Love this resume?Build Your Own Now
APPEALS MANAGER
Career Overview
I desire to use my leadership, educational skills and accomplishments to help an organization achieve business goals and objectives.
Professional Experience
January 2014 to November 2014
HcaKaty , TXAppeals Manager

  • Manage Durable Medical Equipment, wearable cardiac defibrillator called the Life Vest.
  • Acted as a liaison between patient and insurance companies for reconsiderations and appeals for payment for the life vest.
  • Manage 20 Appeal Coordinators, all exempt staff.
  • Full-time) Sharon Kim Mgr.
  • 412-968-3333 HR 40 plus hrs.
January 2005 to April 2013
Dean HealthWisconsin Dells , WIClaims Operations Supervisor
  • Managed two separate departments, 30 direct reports from 2010-2013.
  • I managed Claims Processors for Medicare Part A.
  • insurance.
  • I was responsible to recruit, train, motivate and manage all staff to meet standards timely and efficiently.
  • I developed processes, procedures and coordinated job activities to support program requirements of completing claims within 30 days.
  • I tested benefit updates within the system and created procedures for the new CMS benefit updates.
  • I also motivated employees to perform well within production standards.
  • I managed Qualified Independent Contractor (QIC) clerical employees.
  • The assignments success was measured by a 5-day program requirement for each case received met quarterly.
  • Sue Williams-Mgr.
  • 501 Grant St Pittsburgh 901-791-8676 BCBS of Florida (Full-time) 40 plus hrs.
January 2000 to December 2004
Dean HealthAlbany , WIClaims Operations Supervisor
  • I managed all lines of business within claims processing division.
  • Worked with Indemnity, Major Medical, HMO, Medigap and Point Of Services product lines.
  • I developed and trained staff to complete assignments timely and efficiently.
  • I Monitored the claims outsource companies, Walsh Health Care and Regence Blue Cross Blue Shield inventory.
  • I administered monthly financial disbursements and quarterly reports.
  • In addition, I also supervised 12 Imaging Staff due to operational realignment and was responsible for claims being sorted and Imaged and was accountable for monitoring outsourced claim completion.
  • Lead exempt and non-exempt staff.
  • Mary Ann Jenkins Mgr.
  • 120 Fifth Ave Pl.
  • Pittsburgh Pa 412-544-7000.
  • Full-time) 40 plus hrs.
January 1998 to January 2000
Highmark Blue Cross Blue ShieldCity , STATEOperations Claims Trainer
  • As an Operations Claims Trainer I trained Indemnity Blue Cross Blue Shield, Point Of Service,.
  • HMO, Health Management Organization, benefits for claims processing.
  • I developed training methods and tracked and monitored class success rates as well as provided processing training to help support company demands for skilled processors and customer service representatives.
  • I trained over 15 new hires and existing staff.
  • Introduced training programs that enhanced employee performance and helped build a motivated workforce.
  • Managed and successfully trained staff that were promoted to higher level positions within the organization.
  • Darlene Thomas Mgr, 120 Fifth Ave Pl Pittsburgh Pa 412-544-7000.
  • Full time 40 hrs.
Education
5/99
CARLOW UNIVERSITY
City, State
COMMUNICATIONS
BA
COMMUNICATIONS
12/11
LIBERTY UNIVERSITY

Interests
FLOCK INC. CEO - WOMEN EMPOWEREMENT Mentoring Group 2011- Present. The Youth Project- Volunteer Alternative Education project at Penn Hills High School Self Esteem facilitator, October 2012 - May 2013. Women Empowered for Entrepreneurial Excellence Small Business Jump Start Program graduate 2013. First Antioch Baptist Church of Greensburg -2005-Present Pastor's Wife, Sunday school teacher, Women's Ministry Chair Produced several women's conferences for health, wellness and spiritual growth. Produced "FLAVA" Faith Lives and Victory Abounds" women's conference 2013, "Faithbook Youth Conference" 2012 "Armor of God" youth conference 2010 and the "Power of Praise" 2009, "God's Girls and Goals" 2009, Faith and Business Community Job Fair, Greensburg Pa, November 2013
Additional Information
  • MA CHRISTIAN LEADERSHIP Training/Volunteer Work FLOCK INC. CEO - WOMEN EMPOWEREMENT Mentoring Group 2011- Present. The Youth Project- Volunteer Alternative Education project at Penn Hills High School Self Esteem facilitator, October 2012 - May 2013. Women Empowered for Entrepreneurial Excellence Small Business Jump Start Program graduate 2013. First Antioch Baptist Church of Greensburg -2005-Present Pastor's Wife, Sunday school teacher, Women's Ministry Chair Produced several women's conferences for health, wellness and spiritual growth. Produced "FLAVA" Faith Lives and Victory Abounds" women's conference 2013, "Faithbook Youth Conference" 2012 "Armor of God" youth conference 2010 and the "Power of Praise" 2009, "God's Girls and Goals" 2009, Faith and Business Community Job Fair, Greensburg Pa, November 2013
Skills
benefits, clerical, CMS, Cost-Reduction, Customer Service, documentation, financial, financial reports, Financial report, HR, Imaging, insurance, inventory, Teambuilding, Operations Management, Organizational Skills, Pl, processes, Processors, Project Management, requirement, Supervision, Trainer I, training programs
Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

How this resume score could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

63Fair
Resume Strength
  • Completeness
  • Formatting
  • Word choice
  • Measurable results
  • Strong summary

Resume Overview

School Attended

  • CARLOW UNIVERSITY
  • LIBERTY UNIVERSITY

Job Titles Held:

  • Appeals Manager
  • Claims Operations Supervisor
  • Operations Claims Trainer

Degrees

  • COMMUNICATIONS BA

Create a job alert for [job role title] at [location].

×

Advertisement

Similar Resumes

View All
Manager/-Complaints-&-Appeals/Correspondence-Team-resume-sample

Manager/ Complaints & Appeals/Correspondence Team

Anthem, Inc.

Brooklyn , NY

Pharmacy-Manager,-Medicare-Part-D-Appeals-resume-sample

Pharmacy Manager, Medicare Part D Appeals

United Healthcare

City , STATE

Appeals-Analyst-resume-sample

Appeals Analyst

Reliance Standard

Portland , OR

  • About Us
  • Privacy Policy
  • Terms of Use
  • Sitemap
  • Work Here
  • Contact Us
  • FAQs
  • Accessibility
  • EN
  • UK
  • ES
  • FR
  • IT
  • DE
  • NL
  • PT
  • PL
customerservice@livecareer.com
800-652-8430 Mon- Fri 8am - 8pm CST
Sat 8am - 5pm CST, Sun 10am - 6pm CST
  • Stay in touch with us
Site jabber winner award

© 2022, Bold Limited. All rights reserved.