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Claims Representative Resume Example

Resume Score: 90%

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CLAIMS REPRESENTATIVE
Summary
CUSTOMER SERVICE An entry-level position in Administrative office setting, with opportunity for advancement while using my seasoned experience in medical office applications. I am a dependable, self-starter, and able to work with minimal supervision.
Skills

  • benefits, billing,  
  • charts, email, fax, 
  • insurance forms

  • office equipment, phone, word-processor
  • Cash handling
  • Professionals and friendly
  • Careful and active listener
  • Multi-tasking

Experience
Claims Representative07/2017 to 09/2017Renaissance DentalIndianapolis, IN
  • Answered incoming calls from members and providers.
  • Contacted dental providers for updated info.
  • Telephoned dental companies about  unpaid insurance claims to obtain settlement of claim.
  • Reviewed claims EOB for accuracy.
  • Completed reports for further action and returned incomplete claims to providers for additional data.
  • Processed insurance payments.
  • Enrolled new members in insurance and explained benefits of plans.
Claims Representative07/2017 to 09/2017Renaissance DentalIndianapolis, IN
  • Answered incoming calls from members and providers.
  • Contacted dental providers for updated info.
  • Telephoned dental companies about  unpaid insurance claims to obtain settlement of claim.
  • Reviewed claims EOB for accuracy.
  • Completed reports for further action and returned incomplete claims to providers for additional data.
  • Processed insurance payments.
  • Enrolled new members in insurance and explained benefits of plans.
Hair Stylist10/2014 to 11/2016Great ClipsIndianapolis, IN

  • Maintained up-to-date knowledge of store policies regarding payments, returns and exchanges.
  • Trained   new employees quarterly.
  • Worked as a team member performing cashier duties, product assistance and cleaning.
  • I perform a broad range of beauty services 
  • cutting hair applying  scalp treatments. shampooing, cutting, and styling hair,permanent, hair coloring, and weaving.

Suspended Billing Rep07/2014 to 10/2014SGS Coram CVSIndianapolis, IN

  • processed orders for specialty feeding supplies
  • check for insurance eligibility
  • update patients demographic info
  • verified that a valid prescription  was on file 
  • contacted medical providers for new and update prescriptions 

Health Analyst06/2013 to 04/2014HP Smart IT StaffingIndianapolis, IN

  • Received incoming calls from medicaid and medicare  members as well as providers and  pharmacies 
  • Advised of active insurance  showing on  account .
  • verifying insurance coverage 
  • Received fax and email inquires to have info update 
  • reached out to provider and pharmacies to provide updated info 

Patient care Associate10/2012 to 04/2013Express ScriptsIndianapolis, IN

  • processed orders for specialty life saving medications 
  • update all new demographic info 
  • verified a valid prescription was on file 
  • contacted doctors for update script info
  • set up new accounts for members 
  • tracked lost orders and resent priority to insure that no doses where missed

Customer Service Rep III11/2011 to 12/2012Finish-line Cooperated OfficeIndianapolis, IN

  • placed orders for athletic gear 
  • investigated  lost item request 
  • tracked packages 
  • sent out returned slips for damaged products 
  • check for return of items and processed refunds or replacements 

Claims billing Account processor/ Collector02/2010 to 06/2010Claim-AidIndianapolis, IN

  • processed faxed and emailed claim denials 
  • investigated Eligibility of insurance 
  • updated processing mistakes and resubmitted claims for payment
  • reached out to members for co-pays to settle accounts 


Insurance Processing Clerk01/2008 to 12/2008AnthemIndianapolis, IN

  • reviewed insurance applications to ensure that all questions have been answered, 
  • processed premium payments for  insurance policy 
  • reinstated  lapsed insurance policies to determine automatic reinstatement according to company

Patient Registrar/Patient Service Representative09/2002 to 06/2004Hinesville MedicalHinesville, GA
  • Carefully reviewed medical records for accuracy and completion as required by insurance companies. 
  • Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) support of existing diagnoses 
  • Answered phone and set appointments Scheduled and
  •  confirm patient's diagnostic appointments, surgeries, and medical consultations 
  • Greet visitors, ascertain purpose of visit and directed to appropriate office 
  • Operated office equipment such as voicemail, word-processor, invoices' and medical records
  •  received and routed message 
  •  Fowarded documents such as laboratory results to appropriate staff 
  • compile and recorded medical charts, reports and correspondence, 
  • using a personal computer, fax, and email.
Patient Service Representative11/1999 to 07/2002I U Medical GroupIndianapolis, IN
  • Protected the security of medical records to ensure that confidentiality
  •  maintained reviewed records for completeness, accuracy and compliance with regulations.
  • Entered data, such as demographics, history and diagnostic procedures and treatment  into computer 
  • processed and prepared government forms.
  • Processed patient admission and discharge documents 
  • pulled and filed medical records
  •  Update patient information for billing 
  •  received co-pays and balanced drawer.
Education and Training
High School Diploma: General1987Arlington High schoolIndianapolis, IN, Marion
Certification: Office Administration1997Training IncIndianapolis, IN, MarionMicrosoft ,excel, office procedures people soft outlook
Activities and Honors
graduated valedictorian of training inc
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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.

Resume Overview

Companies Worked For:

  • Renaissance Dental
  • Great Clips
  • SGS Coram CVS
  • HP Smart IT Staffing
  • Express Scripts
  • Finish-line Cooperated Office
  • Claim-Aid
  • Anthem
  • Hinesville Medical
  • I U Medical Group

School Attended

  • Arlington High school
  • Training Inc

Job Titles Held:

  • Claims Representative
  • Hair Stylist
  • Suspended Billing Rep
  • Health Analyst
  • Patient care Associate
  • Customer Service Rep III
  • Claims billing Account processor/ Collector
  • Insurance Processing Clerk
  • Patient Registrar/Patient Service Representative
  • Patient Service Representative

Degrees

  • High School Diploma : General 1987
    Certification : Office Administration 1997

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