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Claims Adjuster with deep experience in confidential litigation claims. Superbly positioned to investigate, evaluate and settle claims. Excellent abilities to decipher fraudulent activities, analyze data, confer with legal counsel and communicate with brokers to gain details for processing claims. Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Highly motivated and committed Medical Assistant with proven history of superior performance at individual, team and organizational levels. Multitasks and prioritizes workloads with little or no supervision. Detail-oriented professional looking to bring medical background and team-building skills to deadline-driven environment.
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- Promoted business via social media to generate leads and maximize brand identity.
- Provided elite customer service by resolving escalated problems and calmly responding to shifting priorities.
- Devised processes to boost long-term business success and increase profit levels.
- Fulfilled customer shipping needs by completing all purchase orders and customer invoices.
- Provided exceptional customer service to customers, increasing customer loyalty 100%.
- Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service.
- Identified and qualified customer needs and negotiated and closed profitable projects with high success rate.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Affirmed or denied coverage fairly based on thorough investigations.
- Investigated damages, gathering information from diverse sources and delivering comprehensive reports.
- Followed up with customers on unresolved issues.
- Evaluated accuracy and quality of data entered into agency management system.
- Analyzed information gathered by investigations to report findings and recommendations.
- Reported policy changes and company conditions affecting customer satisfaction.
- Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
- Verified client information by analyzing existing evidence on file.
- Maintained accuracy, completeness and security for medical records and health information.
- Input data into computer programs and filing systems.
- Reviewed medical records for completeness and filed records in alphabetic and numeric order.
- Communicated effectively with staff, patients and insurance companies by email and telephone.
- Followed exact procedures for handling transfers and other releases of medical records.
- Accurately pulled patient records for upcoming appointments and procedures, typically within 24-hour period.
- Secured medical records against loss or unauthorized access.
- Utilized software to manage and confirm patient data, such as insurance, demographic and medical history information.
- Compiled electronic patient records covering conditions, treatments and diagnoses.
- Prepared and processed forms for government healthcare programs.
- Handled high-volume data entry of demographics, disease etiology and extent and associated procedures or treatments.
- Used correct diagnosis-related groups based on patient encounter details.
- Posted billings to medical insurance providers.
- Compiled, abstracted and coded patient data using classification manuals and standard systems.
- Researched and compiled statistical data to support cost control and care improvement initiatives.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Answered customer questions regarding deductibles.
- Prepared summaries of damage, payments and policy coverage.
- Documented all investigation activity and presented reports to management.
- Conducted authorization requests and provider inquiries by phone, mail or fax to verify member eligibility and benefits.
- Participated in interdepartmental integration and collaboration to enhance continuity of care for client members.
- Maintained confidentiality of client records to comply with HIPAA guidelines.
- Contacted physician offices to obtain missing information from authorization requests as requested by medical director.
- Worked within care access and monitoring team to offer clerical and data entry support for members requiring hospitalization and utilization review for healthcare services.
- Received, recorded and addressed incoming and outgoing communication via telephone and email.
- Organized patient files and streamlined operations to improve efficiency.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Managed office bookkeeping with insurance billing and patient payments.
- Facilitated organized record retrieval and access by maintaining filing system for both in-house and discharged residents.
- Accurately completed insurance and Medicaid billing and OASIS documentation for patient visits.
- Managed financial documentations such as expense reports and invoices.
- Kept detailed records of office inventories and placed orders for more supplies.
- Implemented cpt and icd-9 codes digitizing and organizing medical records.
- Increased office productivity by transcribing over daily meetings and appointments and implementing organizational systems for documents.
Alpha & Omega Career Center - Mobile, AL,
Learned the appropriate process of making a puncture in a vein, with a cannula for the purpose of drawing blood.
Southeast College of Technology - Mobile, AL,
Learned how to create program using HTML format, and also used coding. Created different spreadsheets using a variety of software.
Capps College - Mobile, AL,
Medical Assistant while utilizing training in medical coding and billing, medical transcribing, medical records, insurance verification, medical terminology, law and ethics, and overall patient care and office procedures.
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Resume Overview
School Attended
- Alpha & Omega Career Center
- Southeast College of Technology
- Capps College
Job Titles Held:
- Small Business Owner
- Insurance Claims Processor
- Insurance Claims Adjuster
- Auto Bill Review Processor
Degrees
- Certified Phlebotomist
- General Diploma
- Certified Medical Asisstant
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