claims representative ii processor auditor resume example with 6+ years of experience
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in Military and Government insurance policies, practices and standards.
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- Interviewed policyholders to verify information and obtain additional details.
- Examined reports, accounts and evidence to determine integrity and accuracy of information.
- Followed up with customers on unresolved issues.
- Evaluated accuracy and quality of data entered into agency management system.
- Modeled exceptional customer service skills and appropriate diagnostic sales techniques to team members.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Calculated adjustments, premiums, and refunds.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Determined appropriateness of payers to protect organization and minimize risk.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Maintained confidentiality of patient finances, records and health statuses.
- Verified client information by analyzing existing evidence on file.
- Generated, posted and attached information to claim files.
- Processed and recorded new policies and claims.
- Coordinated with contracting department to resolve payer issues.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Posted payments to accounts and maintained records.
- Checked documentation for accuracy and validity on updated systems.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Received inbound calls and conducted outbound calls while completing investigations for missing UPS packages.
- Promoted performance management practices and helped instill strong culture focused on protective policies and procedures.
- Developed short-term goals and long-term strategic plans to improve risk control.
- Employed strong program management skills to successfully define and manage ongoing initiatives designed to control decline in production.
- Trained and mentored agents on organization, analytics and influential communication.
- Advised senior managers on policy strategies for reducing liability and preventing losses.
- Monitored employee tasks, evaluating information processing and performance to gauge business functions and inefficiencies.
- Evaluated training procedures for employees, designing improvements and alterations based on statistical feedback and observation.
- Recommended technology upgrades and complementary products to improve client security.
- Collaborated with client and interdepartmental peers to transform client requirements into turnkey solutions.
- Evaluated and adopted new technologies to address changing industry needs.
- Communicated employee feedback and observational discoveries to senior officials, advocating for needed technical changes to testing protocols.
- Authored best practices documentation for use in existing personnel training and new personnel onboarding processes.
- Assessed business needs and problem areas to create focused solutions.
- Monitored equipment and tools and completed projects within time limits.
- Investigated and addressed system issues to enhance usability and improve functionality.
Adopt a Family Holiday Sharing Program - Advisor December 2013 – Current
Responsible for advising and providing guidance to the program which has managed more than 500 volunteers since its inception and serving more than 40 family and a women’s shelter by providing them with items in need and holiday programming.
Food & Need Collection Programs (Various) – Advisor/Volunteer December 2009 – Current
Responsible for collecting items for individuals suffering from homelessness, domestic violence, and other areas of impact. Advisement and programming have contributed to the following programs since 2009: Teens for Jeans, Martha’s Table, Bowie Food Pantry, Transitions Women’s Shelter, and victims of many disasters over the years.
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Resume Overview
School Attended
- Hampton University
- Episcopal High School
Job Titles Held:
- Claims Representative II/Processor/Auditor
- Package Investigation Analyst
- Senior Technical Consultant
Degrees
- Some College
- High School Diploma
By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy