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Claims Insurance Validator Resume Example

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Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Professional Summary

Personable Customer Service professional offering experience resolving account and service concerns for customers. Smoothly uncovered and solved challenges while promoting company products and maintaining loyal, satisfied customers. Focused on surpassing expectations and driving team success.

Skills
  • Professional Customer Service
  • Organization
  • Communication Skills
  • Time-Management
  • Decision Making
  • High Attention to details while multi-tasking
  • Complaint Resolution
  • Working knowledge and understanding of assisting patients and customers with pharmacy benefits better.
Education
Midland Lutheran College Fremont, NE, Expected in Bachelor of Science : Business Administration And Management - GPA :
American Academy of Professional Coders Cincinnati, OH, Expected in 08/2022 Certification : Medical Billing Specialist - GPA :
  • ANTICIPATION COMPLETION OF CERTIFICAITON of Medical Billing Specialist expectation of August, 2021.
  • Medical terminology certification.
  • Continuing course work in Medical Billing Training.
  • ICD-10 Book Course
  • On-line Course work
Certifications
  • Medical Terminology Certification December 3, 2019
Work History
Panera Bread Co - Claims Insurance Validator
Prairie Village, KS, 09/2020 - Current
  • COB and Insurance Eligibility, which includes: primacy rules for priority payment, integration of benefits, Medicare training, secondary insurance, end stage renal disease.
  • Established & understanding of reason codes: dependent not covered, payment prior to coverage, terminated coverage, lapse of coverage.
  • Established & understanding of Medical terminology: Medical Terminology Certification.
  • Established understanding of terms, example: advanced beneficiary notice, prior authorization, timely filing, non participation provider, participating provider, remittance advice.
  • Documentation of each account for accuracy in reference to details of eligibility.
  • Being in compliance with HIPAA on all accounts.
  • Documented entire validation process, noting changes or alterations completed.
  • Working from home since July, 2020.
  • Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity
City Of Norfolk, Va - Third Party Liability Claims Researcher
Norfolk, VA, 03/2020 - 09/2020

CURRENTLY WORK AT THIS EMPLOYER: FIRST JOB BEFORE MOVING TO INSURANCE VALIDATION POSITION

  • Contacting attorney's offices, representatives of insurance carriers, insurance carrier adjusters, and workmen's compensation carriers for medical claims to determine if there is potential case for third party liability.
  • Established and updating all account information to ensure that all information is accurate for future referencing.
  • Performance compliance with HIPAA on all accounts.
  • Performing coordination of benefits with auto and third party auto carriers.
  • Performing documentation of each account for accuracy in reference to details for managing account and medical expenses.
  • Establishing and obtaining information from attorney's offices, insurance adjusters, and workmen's compensation by letters for determination of interests on when necessary.
  • Managing over 35 calls per day.
  • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines
Walgreens - Customer Service Associate
City, STATE, 10/2018 - 04/2019
  • Politely assisting customers and responding resourcefully to requests and request concerns.
  • Issuing credit(s) and refunds after approval by management. Placing items in correct area for reporting on defective or damage items resulting from shipping process.
  • Processing and managing over 100 purchases per day and handling transactions through POS system.
  • Increasing customer service by decreasing waiting times.
  • Stocking, rotating, and removing items near expiration date from all locations to ensure items are used within recommended time frames.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Maintained clean personal appearance of store when by stocking shelves, organization and arrangement of merchandise.
Dodge County Court - Records Clerk
City, STATE, 06/1991 - 09/2017
  • Developed and initiated monthly payment plans for customers on outstanding accounts, both small and large accounts.
  • Communicating with customers about their account(s) and collecting outstanding balances.
  • Researched and resolving any questions or concerns on account balances for customers immediately.
  • Posting payments, providing change back when necessary and issuing receipts.
  • Clerical duties and tasks, including: scheduling, directing phone calls, filing, batching mail, weekly postage outgoing mail for office, taking messages for appropriate staff members, and greet visitors.
  • Maintaining attorney database accounts weekly by keeping accounts in good standing.
  • Bi-weekly attorney billing.
  • Cashiered, balancing daily cash drawer, and cash handling.
  • Receiving and routing medical records to appropriate files for scanning.
  • Maintained current and accurate medical records for over 300 juvenile court cases per year.
  • Creating and preparing legal drafts by organizing and assembling information for legal documents and forms.
  • Professional customer service in friendly, efficient manner ,
  • Scanned paper documents into computer and assigned identification numbers to simplify tracking process updating records with new information.
  • Sorted all paperwork and documents alphabetically and according to dates and significance.
  • Updated records with new information.
  • Assisting with typing, data entry and answering incoming calls as required.
Accomplishments
  • Saving the county large amounts of funds by implementing cost-saving initiatives that addressed long standing problems, after approval from the County Attorney and Judge for reimbursement court costs.
Additional Information
  • Ability, working knowledge and skills in identifying and empathy to address patient concerns
  • Escalate appropriately, and when necessary when issues arise.
  • Computer proficiency
  • Account documentation.

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Resume Overview

School Attended
  • Midland Lutheran College
  • American Academy of Professional Coders
Job Titles Held:
  • Claims Insurance Validator
  • Third Party Liability Claims Researcher
  • Customer Service Associate
  • Records Clerk
Degrees
  • Bachelor of Science
  • Certification