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Medical Claims Representative/Claims Adjuster Resume Example

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MEDICAL CLAIMS REPRESENTATIVE/CLAIMS ADJUSTER
Professional Summary

Who is Candace E. Walker-

I am a person who loves helping, it is the core of who I am and how I was raised. I have a strong work ethic, passion for continuous education of self, hyper focused and astute. I find details that most miss or may not be aware of and this has always helped me in my career history. I enjoy a fast paced environment, and adapt well to unexpected situations. I believe in spreading light where there is darkness, and that simply means, if i can make someone smile and feel good for one moment, I have succeeded in life at that moment. This mindset propels me forward, keeps me curious, and a valuable team player, as I think of my team in my actions. Efficiency, attitude, and diligence are key traits i hold.

I re-built a motorcycle from the ground up, because, well I never had and wanted a motorcycle. I didn't know electronics, or small engine repair, but I learned. The outcome was a beautiful replica of a 1950's bomber war style bike. Determination, knowledge, courage.

Work History
Progressive - Medical Claims Representative/Claims AdjusterTigard, OR08/2018 - Current
  • Managed large volume of medical claims on daily basis.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Paid or denied medical claims based upon established claims processing criteria.
State Of Idaho Department Of Human Services - Human Services Case ManagerBoise , ID03/2015 - 08/2018
  • Compiled socioeconomic data for specific program eligibility determinations and large-scale research purposes.
  • Answered high volume of calls and provided assistance through effective listening and question response skills.
  • Met with clients to conduct assessments of current situations and establish what needs to address.
  • Established positive relationships with aid recipients and assessed goals, working hard to address individual needs and tailor services to suit them.
Peterson Stampede Dodge Chrysler Jeep - Internet Sales ManagerNampa, ID04/2013 - 06/2015
  • Exceeded targets by building, directing and motivating high-performing sales team.
  • Liaised with sales, marketing and management teams to develop solutions and accomplish shared objectives.
  • Encouraged cross-selling of additional products and services through relationship-building and acquired understanding of customer business needs.
  • Monitored customer buying trends, market conditions and competitor actions to adjust strategies and achieve sales goals.
Federal Government/Contract ACA - MAXIMUSBoise , Idaho03/2014 - 03/2015
  • Spent ample time with each customer, verbally reviewing and explaining documents for client comprehension.
  • Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
  • Performed needs analysis to obtain information required to make appropriate health insurance product recommendations.
Humpty's Bar And Grill/First Round Bar And Grill - Bartender/ManagerAlbany, Oregon09/1998 - 01/2012
  • Supervised and trained staff on preparing and delivering drinks, handling food and money and setting up bar at beginning of shift and breaking down at end of shift to facilitate operations.
  • Oversaw and monitored all cash drawers and reconciled drawers against cash register reports at close of business.
  • Scheduled parties, banquets or sporting events and allocated optimal staff and resources to properly execute.
  • Developed new signature cocktails to support bar marketing brand and increase profits.
  • Applied excellent organizational and multitasking abilities to handle simultaneous customer, team and business needs while avoiding unnecessary delays or errors.
  • Poured and prepared mixed drinks for customers daily and created new libations drawing in clientele.
Skills

Recordkeeping skills

  • Digital file organization
  • Workflow coordination
  • Project assistance
  • Leadership
  • MS Office/PowerPoint/Sharepoint/Typing/EFAX
  • Teambuilding
  • Supervision
  • Multitasking abilities
  • Critical thinking
  • Data management
  • Front office operations
  • Event Coordination
  • Ordering supplies
  • Customer support
  • Detail-oriented
  • Recruitment
  • Medical Records Management
  • Staff education and training
  • Case management
  • Interviewing skills
  • Program development
  • Claims reporting systems
  • Auto insurance
  • Client needs analysis
  • Health insurance
  • Quotes and sales
  • Policy renewals
  • Risk mitigation
  • Negotiation
  • International sales support
  • Report preparation
  • Complaint resolution
  • Inbound and Outbound Calling
  • Medical terminology knowledge
  • Account management
  • CRM
  • POS systems expert
  • Multi-line phone talent
  • Technical Support
  • Professional telephone demeanor
  • Creative problem solving
  • Document review
  • Federal and state regulations
  • Investigations skills
  • Troubleshooting
Education
Expected in 06/2021
Ashworth College
ONLINE
CRCST: Sterile Processing Technician
College of Wester Idaho
Boise, ID
Some College (No Degree): Web Design-Office Specialist
06/2005
Linn Benton Community College
Albany
Associate of Arts: Business And Supervisory Management
  • Coursework in Psychology, Business, Accounting, Social Economics and Marketing.
  • Extra courses taken in Self improvement, Life enhancement skills, Communication, and Stress Management.
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Resume Overview

Companies Worked For:

  • Progressive
  • State Of Idaho Department Of Human Services
  • Peterson Stampede Dodge Chrysler Jeep
  • Federal Government/Contract ACA
  • Humpty's Bar And Grill/First Round Bar And Grill

School Attended

  • Ashworth College
  • College of Wester Idaho
  • Linn Benton Community College

Job Titles Held:

  • Medical Claims Representative/Claims Adjuster
  • Human Services Case Manager
  • Internet Sales Manager
  • MAXIMUS
  • Bartender/Manager

Degrees

  • CRCST : Sterile Processing Technician
    Some College (No Degree) : Web Design-Office Specialist
    Associate of Arts : Business And Supervisory Management

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