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Manager Medical

Location:
Houston, TX
Salary:
40,000.00
Posted:
July 29, 2016

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Resume:

Mrs. Terry Holden

**** ****** **** **

Houston, Texas 77086

281-***-****

acvxdl@r.postjobfree.com

I have paid almost all plans through out the years. I know the ins and outs of the Insurance business. Although I have been out of the business since 1999, I quickly pick up new programs and the knowledge of claims, is still there. I am eager to learn new plans, and systems.

Types of plans paid: Met, Tru-group, TPA, PPO, PHN, EPO, STD, LTD, HMO, Dental, Comprehensive Major medical, Basic Major medical And Medicare.

I have had experience in Quality Control, Evidence of eligibility, Right of recovery, efficiency/production reports, and trained new employees. Worked with Agents, providers and policy holders in regards to any problems they may have or just status of claims.

If the job requires anything to do with processing claims or appeals for denied claims I can do it. I can also verify coverage and understand policies.

I am quick to learn new computer programs, and have paid claims on paper a long while ago. I have paid individual claims and group claims. Show me the programs and the job at hand and I will be ready to go.

I also have had dealings with my last husband's businesses. One was a restaurant, the other a body shop both across the street from one another. I did the books, W-2s, dealt with personnel, managers and workers. I was also working a full time job.

I am looking for a full time job as a Manager/Supervisor/Team Lead, in Insurance claims processing.

I am not licensed to sell.

Mrs. Terry Holden

6511 Bryant Park Ct.

Houston,Texas 77086

281-***-****

Required income: $35-55K per year, negotiable

Employment History:

BC/BS or Texas/ Previously Aetna /New Your Life

10/13/1996-09/17/1999

Team Lead for Claims and TDI Appeals.

Watched over the appeals claims department making sure the appeals were processed within the states guidelines by auditing various claim appeals, and accurately, auditing various claim appeals. I would go to daily meeting for all denied claims, along with supervisor, manager and director of claims. Helped pay claim appeals and TD.I. appeals so we could keep within guidelines. Trained new employees.

Central United Ins. Co.

3/1994-10/1996

Claims Processor

Paid Individual plans for: Cancer, Hospitalizations, STD, LTD,

Accident policies, policies for travel to hospital from home and back,

also paid dental claims. I enjoyed working here, because it never got dull, so many different policies.

United States Life Ins. co. (Dallas)(Halliburton)

4/11/88-11/6/1990

Team Leader for claims area.

Watched over claims and gave opinions and help to the claims personnel when needed. Also would look up unpaid control #’s. Reports given to Supervisor.

Health Economics Corp. (Life of the Southwest) Dallas

1/05/1987-4/3/1988

Senior claims examiner.

Helped with claims processing and trained new employees

Audited claims chosen randomly off of claims processors desks. Also learned to pay HMO, PPO, EPO along with major medical claims.

elp

G.I.C. Ins. Co. - Houston

01/17/1985-11/19/1986

Claims Examiner

Paid claims, Major Medical. Checked for right of recovery

Checked for pre-existing conditions.

Provident Life Ins. Co.

5/6/1979-7/20/1983

Claims Examiner/Group plans.

This is where I was trained to be a claims processor. Each

Examiner was given a large group to handle, therefore getting to know the people

Agents and providers.

Prior to the job at Provident I worked at an Agents office

R.B. Colvin: Secretary

After that I worked at J.H. Blades, Agents office

Mail clerk



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