Detail-oriented, group health, disability, and flexible spending account claims professional seeking employment with stable company, utilizing data-entry skills and effective telephone and written customer service skills.
Review and adjudicate group disability claims. Review claim forms for completion and accuracy. Obtain additional information by written correspondence, e-mail correspondence, and telephone contact for file documentation and decision making purposes. Determine eligibility for benefits. Accurately determine compliance with contractual policy provisions, and determine amount of benefits payable. Complete adjustments with accuracy. Complete data entry to issue payments, complete adjustments with high accuracy. Complete overpayment recovery as needed.
Reviewed claims for all detail required to process claims submitted. Requested additional information from multiple sources as necessary to complete claim processing. Determined eligibility and plan coverage for health bills, disability claims, and flexible spending account benefits in accordance with plan provisions. Entered claim data into computer data base. Determined amount of benefits payable with high accuracy. Initiated claim payment or denial in accordance with procedures and processes. Maintained current and accurate claim and plan documents. Identified system problems and communicated these issues to appropriate departments for further review and correction. Provided accurate and timely customer and client service by telephone and written correspondence for verification of benefits, benefit coverage, eligibility, claim issues, denials, and other customer service needs.
Dean's List 2.98 GPA (on 4 point scale)
Completion of this university level program provided me with the skill to analyze and understand written materials, including contractual language such as insurance policies, as well as compose verbal and written correspondence for clients and customers.
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