Senior Claims examiner

PROFESSIONAL SUMMARY

EDUCATION EXPERIENCE

SKILLS

San Antonio, Texas

ad5cow@r.postjobfree.com

APRIL FOX 210-***-****

Business Professional

Results-driven business professional with extensive experience in Client Relations, Office Operations, Calendar Management, Training/Mentorship, and Dynamic Workflow Optimization. Seeking a growth-oriented opportunity to apply my goal-centric mentality and resourcefulness towards a career in Human Resources.

NLB Services Aug. 2022 - Aug. 2023

Processed voluntary accident claims

Reviewed and handled medical

records/confidential information within HIPAA

guidelines

Consistently met all monthly metrics

Made claim outcome decisions

Apex Temp Agency Nov. 2020 - Dec. 2020

Processed Amazon COVID-19 claims from

inception to close

Reviewed and maintained proper organization

of confidential documents

Managed inbound/outbound employee calls

World Financial Group Sept. 2019 - Feb. 2023

Provided guidance and sales of life insurance

and annuities

Consulted with prospective clients, facilitating

sales of homeowners and auto insurance

Developed leads via networking, consultative

communication, referrals, and CRM

Onboarded new insurance clients, provided

necessary assistance post-sale

Recruit additional Financial Advisors to the

WFG Team

Associate’s Degree in Business

Administration

CRM and Database Systems

Microsoft Office Suite

Benefits Coordination

Demographic Data Collection

Claims Examination and

Managed Claims Criteria

Data Operations and EOB/RA

Aptitude

Insurance Verification

Computerized Billing

HIPAA Compliance

Appeal Letter Writing

Senior Claims Examiner

Amazon Human Resources

Financial Advisor

University of Phoenix

CORE COMPETENCIES

Strong Organizational and

Time-Management skills

Task Prioritization and

Adaptability

Interpersonal Communication

/Relationship Building

Skilled in both Independent

and Collaborative Teamwork

Settings

High-Accuracy Data Entry

Senior Claims Examiner

UnitedHealth Group Aug. 2014 - Nov. 2017

Diligently processed Self-funded medical claims

and Medicaid/Medicare claims

Managed inbound and outbound provider calls

Showcased strong goal-attainment abilities in

continuously met quality and quantity

requirements

Texas All-Lines Adjuster

License

CERTIFICATIONS

Web TPA Aug. 2017 - May 2019

Processed Voluntary Benefit Claims as a

Licensed Adjuster for critical illness, accident,

and hospital indemnity plans

Examined and completed Medicaid/Medicare

and Self-Funded medical claims

Provided new hire training and ongoing

mentorship to 10 new Adjusters throughout

tenure

Met and exceeded monthly quality and quantity

requirements

Outbound communication to provider(s) for

documentation

Senior Claims Adjuster

Medical Terminology, Billing/Coding

Contact this candidate