Medical Claims Examiner Resume Example Healthnow Administrative Services

MEDICAL CLAIMS EXAMINER

Summary

Driven Medical Claims Examiner trained in all aspects of insurance claims and collections. Employs high-level negotiation skills in resolving claims to the satisfaction of all involved parties. Analytical thinker and innovative problem solver.

Highlights

Thrives under pressure

Organized

Self-motivated

Customer advocate

Complaint handling and resolution

Microsoft Word

Microsoft Excel

Medical coding

Facets 5.0.1

Experience

Medical Claims Examiner08/2001 to 01/2015
Healthnow Administrative ServicesBlue Bell, PA

Processes Bluecard Medical, Dental, and Flexible Spending Account (FSA) Claims.
Processes Adjustments Of Claims
Manages Correspondence.
Maintains Production And Quality Standards By Ensuring All Claims, Correspondence And Adjustments Are Processed In Accordance With Company Guidelines
Responds To Routine Request From Providers, Claimants, Brokers, And All Interest Parties, In Writing Or Orally
Able To Verify Coverage In Accordance With Company Guidelines And All State And Federal Laws
Verify And Request Medical Information From The Insured, Claimants And Medical Providers

Data Entry Operator - Pre Processor07/1999 to 08/2001
Healthnow Administrative ServicesBlue Bell, PA

Enter Health Insurance Policy Information Into The Network Data Base.
Data Entry (12,000 Keystrokes)

Data Entry/Coding Specialist11/1997 to 05/1999
United National GroupBala Cynwyd, PA

Processed The Issuance Of New Policies
Trained & Instructed Coding Department Utilizing The Wins AS400 Computer Network System
Ability To Enter Both Property & Liability Policy Information Processed All Incoming & Outgoing Policy Cancellations

Record Maintenance Clerk05/1996 to 11/1997
United National GroupBala Cynwyd, PA

Handling of Heavy Mail Flow.
Date Stamped & Processed All Incoming and Outgoing Mail.
Delivered Mail Throughout Claims Department.
Processed Incoming & Outgoing Faxes
Pulled Incoming & Outgoing Policies by Color and Number Codes.
Accounted for over 12,000 Company Records
Assisted In The Implementation Of Automated Record Tracking System That Increased Productivity by 25%

Military Experience

Inventory Management/Operations Specialist12/1991 to 12/1995
United States Air Force

SECRET Security Clearance

Honorable Discharge

Earned Numerous Awards, Medals, And Commendations Including Good Conduct Medal
Trained Personnel In Standard Base Supply System Computer Operations And The Core Automated Maintenance Systems Operations
Awarded Airman of the Year, 335th Fighter Squadron, 1992.
Awarded Technician of the Year, 335th Fighter Squadron, 1993.

Education

Sociology, EducationBloomsburg UniversityBloomsburg, PA

Sociology Education Completed 72 Credit Hours

Resume Overview

Companies Worked For:

Healthnow Administrative Services
United National Group
United States Air Force

School Attended

Bloomsburg University

Job Titles Held:

Medical Claims Examiner
Data Entry Operator - Pre Processor
Data Entry/Coding Specialist
Record Maintenance Clerk
Inventory Management/Operations Specialist

Degrees

Sociology, Education

Medical Claims Examiner Resume Example

Resume Score: 80%

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