team lead stop loss claim examiner resume example with 8+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - -
  • Eight years dedicated stop loss medical claim examination experience
  • Experienced in CPT, ICD-9 & ICD-10 coding
  • Proficient with Microsoft Office Suite programs
  • Facilitate meetings for departmental objectives, goals, and assignments
  • Communicate directives to staff
  • Resolve client questions and dissatisfaction
  • Excellent time management, organization, and analytical skills
  • Coordinate departmental workflow and processes Stop Loss Medical Claim Examiner
  • Auditing of specific stop loss claims
  • Develop and maintain department policies and procedures
  • Adjudicate and determine appropriate reimbursement in accordance with underlying insurance contract
  • Communicate with external clients regarding claim questions, payments and denials as needed
  • Assist in staff onboarding and training
  • Organize team workload to maintain inventory and turnaround time with company goals
  • Creation and maintenance of company-wide policies and procedure guides for multiple companies
  • Streamline work process flow
  • Produce one stop resource and reference guide September 2017 – Present Team Lead, Stop Loss Medical Claims Corporate Benefits Audits, North Andover, MA November 2013 – July 2017 Stop Loss Medical Claims Examiner Arbor Benefit Group, Farmington, CT June 2013 – November 2013 Billing & Follow Up Representative Trinity Health, Boise, ID May 2012 – June 2013 Team Lead Supervisor Caption Call, Meridian, ID Currently enrolled in bachelor degree for Business Administration – Southern New Hampshire University Associates Degree of Applied Science, (Medical Assistant) – Brown Mackie College, Boise, ID High School Diploma – William H.Hall High School, West Hartford, CT

Forward-thinking Team Lead Supervisor with eight years of relevant work experience. Offering excellent problem-solving, communication and multitasking abilities. Background planning and managing innovations to existing processes, implementing new processes organizing reference guides.

  • Production monitoring
  • Quality control
  • Resource allocation
  • Team supervision
  • Client support
  • Quality Improvement
  • Training
  • Issue resolution
  • Experience in leadership
  • Program evaluation
  • Ability to analyze reports
  • Analytical
09/2017 to Current
Team Lead, Stop Loss Claim Examiner Captioncall Llc Phoenix, AZ,
  • Assessed, motivated and empowered team members to work to build customer satisfaction and loyalty, to support retention and growth.
  • Paid and processed claims within designated authority level.
  • Developed and implemented policies, procedures and process improvement initiatives
  • Enforced adherence to company policies, answered coworkers' questions and trained new personnel.
  • Promoted to leadership position in recognition of strong work ethic and demonstrated ability to improve workflow
  • Directed and led employees, supervising activities to drive productivity and efficiency.
  • Coordinated with internal departments to maximize operational efficiency across production and administrative areas.
  • Optimized project development and roll-out through in-depth technical research and analysis
  • Investigated questionable claims to determine payment authorization.
  • Trained new employees
  • Evaluated employee performance, identified areas of improvement and communicated plans to employees.
  • Delegated daily tasks to team members to optimize group productivity.
  • Developed open and professional relationships with team members, enabling more effective issue resolution.
  • Obtained all necessary information to complete proper evaluation of claims.
  • Integrated process improvements to increase overall workflow.
06/2013 to 07/2017
Stop Loss Medical Claims Examiner Arbor Benefit Group, LP City, STATE,
  • Efficiently and effectively processed a large volume of medical claims on a daily basis.
  • Inputted data into the system, ensuring that provider coding information and reported services were correct.
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
  • Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
  • Based the payment or denials of medical claims upon well-established criteria for claims processing.
  • Documented file notes clearly and concisely
  • Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.
06/2013 to 11/2013
Billing and Follow up Representative Trinity Health System City, STATE,
  • Executed medical billing including submitting claims to insurance companies and researching and resolving denials and explanation of benefit rejections within billing cycle timeframe.
  • Assessed and resolved variances in accounts, databases and bills.
  • Worked with outside parties to obtain payments and solve problems.
  • Verified proper coding on, investigating and resolving issues to maintain billing accuracy.
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
  • Resolved variances in accounts and reconciled histories with bank statements.
05/2012 to 06/2013
Team Lead Supervisor CaptionCall City, STATE,
  • Complied with company policies, objectives and communication goals.
  • Provided ongoing training to address staff needs.
  • Realigned workflows with changing business demands by evaluating processes and employee strengths.
  • Performed minor equipment repairs to keep jobs on task and notified maintenance department of major machinery failures.
  • Established and maintained operating schedules to provide effective coverage for key areas and achieve objectives.
  • Conducted evaluations and reviews for 15+ employees at a time.
Education and Training
Expected in 2013
Associate of Science: Medical Assistant
Brown Mackie College - Boise, ID,
Expected in
BBA: Industrial Organizational Psychology
Southern New Hampshire University - Hooksett, NH

Fellowship, Health Insurance Advanced Studies

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Resume Overview

School Attended

  • Brown Mackie College
  • Southern New Hampshire University

Job Titles Held:

  • Team Lead, Stop Loss Claim Examiner
  • Stop Loss Medical Claims Examiner
  • Billing and Follow up Representative
  • Team Lead Supervisor


  • Associate of Science
  • BBA

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