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Claims Manager Resume Example

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CLAIMS MANAGER
Summary

Objective: To obtain a position with an organization that provides an opportunity to strengthen and diversify my skills and experience, with potential for advancement.

Skills
  • Problem solving skills
  • Processes
  • Proofreading
  • Claims Adjustments
  • Claims Investigation and Research
  • Claims Analysis
  • Reading Comprehension
  • Document Management System Software
  • Monitoring
  • Coordination
  • Active Learning
  • Handle Customer Complaints
  • Claims Procedures
  • Claims Processing
  • Claims Knowledge
  • Data Entry Software
  • Web Browser Software
  • Billing Software
  • Analyze Claim Files
  • Handle Incoming Insurance Claims
  • Operation and Control
  • Manage Claims Process
  • Manage Claim Files
  • Verbal and Written Communication
  • Compensation Analysis
  • Microsoft Internet Explorer
  • Billing
  • Billing Inquiries
  • Patient Billing
  • Data Entry
  • Patient Contact
  • Spreadsheets
  • Claim and Billing Resolution
  • Customer Billing
  • File Management Systems
  • Invoice Processing
  • Billing Systems and Software
  • HIPAA Compliance
  • HIPAA Regulations
  • Data Verification
  • Active Listening
  • Critical Thinking
  • Complex Problem-Solving
  • Microsoft Office
  • Microsoft Outlook
  • Microsoft Excel
  • Time Management
  • Email Software
  • Microsoft Word
Experience
Company Name | City, StateClaims Manager09/2020 - 02/2021
  • Claims Processing and management of workers compensation claims for hearing aid patients.
  • Utilizing standard operating procedures, problem solving, and investigation to the workers compensation hearing services cycle, including reception of referrals, submitting quotes to TPAs/adjuster, obtain purchase orders, authorizing providers to provide services and order devices to be billed to corporate accounts, to billing insurance carriers.
  • Facilitator and liaison between audiology provider offices, insurance carriers, adjusters, and DME vendors.
  • Advocate for workers compensation patients to ensure services, devices, and supplies are delivered in a timely manner.
  • Ensuring that requests submitted by audiologists and provider offices are processed, compensated, and billed in a timely manner.
  • Communicating claim status and processes with patients, providers, and adjuster.
  • Fulfillment of sales orders in the TCM billing system.
  • Ensuring proper invoicing to customers by referencing CRM and TCM software.
  • Communication and collaboration with coworkers to maximize effectiveness and efficiency of operational procedures.
  • Developed consistent procedures and process improvement initiatives company-wide, resulting in increased profits.
  • Submitted clean claims to reduce denial rates, following payer reimbursement policies and procedures.
  • Checked into questionable claims, interviewing providers, vendors, and claimants to resolve errors and omissions.
  • Created master spreadsheet to record request intake status, including denials, approvals, and fulfillments.
  • Improved operations by working with team members and customers to find workable solutions.
  • Analyzed information gathered by investigations and reported findings and recommendations.
  • Identified client service improvement opportunities in collaboration with team members and supervisors to resolve problems.
  • Coordinated benefits with workers compensation insurance plans and hearing aid healthcare providers.
  • Verified claim data correctness in preparation for processing.
  • Leveraged TCM and CRM to input and compile data gathered from various sources.
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Company Name | City, StateInsurance Premium Billing Processor02/2018 - 09/2018
  • Billing & Client Services for multiple life insurance clients.
  • Application/reversal of premium/loan payments and various accounting duties (including accounts payable/receivable) for policy maintenance.
  • Using analytical and problem-solving skills to resolve premium issues/inquiries.
  • Utilizing multiple applications, databases, and systems respective to each individual client.
  • Monitoring, researching, and responding to work items in lockbox question queues, including (but not limited to) premium/policy billing inquiries and manual payments.
  • Ensuring work items are completed within set timeframes.
  • Creating journal entries and completing batch processing to enable transfer of funds.
  • Communication with offshore agents in order to resolve premium/policy related inquiries.
  • Processing premium chargebacks.
  • Resolution of premium-related issues with fellow team members operating via remote locations.
Company Name | City, StateMember Service Representative08/2017 - 12/2017
  • Answering incoming calls from members in response to account and product service inquiries.
  • Process transfers/stop payment requests, general requests, and general account research as requested by members.
  • Using analytical and problem-solving skills to recognize and resolve account/payment issues.
  • Helped members resolve account problems and navigate internal systems to handle routine needs.
  • Assisted in maintaining accurate records by verifying and updating member account information.
  • Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
  • Processed over [Number] cash and check deposits per day with [Number]% accuracy rate.
Company Name | City, StateEmployment Security Representative01/2011 - 08/2016

Handling inquiries from claimants, employers, and other customers regarding Unemployment Compensation/Reemployment Assistance claims & benefits. Explanation of claim status, procedural instructions and laws regarding benefits, including monetary eligibility, authentication, potential issues, disqualifications, adjudication, & appeal processes. Accessing and researching necessary records and databases in combination with analytical/problem solving skills in order to recognize and resolve claim issues.Using analytical/problem solving skills to detect and report potential overpayments and fraud. Completion of fact-finding forms to be submitted for adjudication processes. Authentication of claimants & processing pin reset requests to assist with prevention and detection of fraudulent claims/identity theft. Processing reports of identity theft upon request from victims and employers. Reporting incidents of technical issues with the software program utilized with maintenance of the benefits system. Manual processing of payments. Assisting claimants with exceptional needs with filing new & additional claims, reopening claims, &, requesting benefit payments.

  • Recognized by management for providing exceptional customer service.
Education and Training
FLORIDA STATE UNIVERSITY | CityBachelor of Science in Communications/Media Production
  • Magna cum laude graduate
  • Major in Media Production
  • Minor in Film Studies
  • Lambda Pi Eta Member
FLORIDA STATE UNIVERSITY | CityBachelor of Science in Elementary Education
PALM BEACH STATE COLLEGE | CityAssociate of Arts Degree
  • Composition Student Of The Year Recipient
  • Major in Education
  • Honor Roll
  • National Dean's List Honoree
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Resume Overview

School Attended

  • FLORIDA STATE UNIVERSITY
  • PALM BEACH STATE COLLEGE

Job Titles Held:

  • Claims Manager
  • Insurance Premium Billing Processor
  • Member Service Representative
  • Employment Security Representative

Degrees

  • Bachelor of Science in Communications/Media Production
    Bachelor of Science in Elementary Education
    Associate of Arts Degree

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