Medical Training

Jamie Starr

** ****** ****** **, *****, AR *****

501-***-**** *.******@****.***

Objective: Association with an organization that will benefit from my skills and abilities,

ultimately qualifying for advancement and increased decision making responsibilities.

Experience:

4/11-8/13: Arkansas Blue Cross Blue Shield

Special Claims Adjuster

• Use analytical skills to adjust and analyze claims for correct payment.

• Trained on and worked all pends and adjustment codes.

• Read and understand Utilization Review edits.

• Work and Test Claims Check Plus pends and adjustments.

• Protrac requests.

• Pull reports from Vista and HOD.

• EBD reject file report project.

• Special projects

• Amisys Release testing 6.0.

• Review, interpret and apply benefits appropriately.

• Ensure all systems related to benefits and accumulators are properly adjusted.

• Research problems utilizing systems and processing manuals.

• Work closely with other departments in processing adjustments.

• Responsible for y7 at the header report, EBD reject file que, retro term report (customer

accounts), a2 adjustment report, Corrected Claims, reinstate, and other adjustment ques.

• EEC Representative and responsibilities for Health Advantage.

4/07-4/10: Gallagher Bassett Services, Inc.

Claims Representative

• Analyze and process Indemnity Workers’ Compensation Claims.

• Maintained professional, positive communication with clients and agents.

• Adhere to special claim handling guidelines/performance guarantees specific to clients.

• Reviewed and adhere to Best Practices and Product Standards

• Participated in ongoing training and education to maintain Adjusters License

• Maintain a current Adjusters License for the State of Arkansas

• Maintained a diary, E-mail and voice mail n a daily basis

• Scored 90% o better on client and company reviews/audits

• Submitted detailed status reports and controlled loss reports daily.

• Kept E-bill an E-invoices paid on a daily basis

• Maintained a closing ratio of claims

• Addressed reserves for the lifetime of the claim on initial set up after investigation complete

• Completed 3 point contacts to Employer, Employee an Medical Provider after receiving notice of

a new claim.

• Managed Litigation on files and direct counsel to participate in case strategies.

• Attended legal hearings when needed to.

• Obtained Litigation plan and budget from counsel

• Completed plan of action for all claims to move files toward closure.

• Managed and directed nurse case managers on files they were assigned to.

• Ability to understand an Insurance contract/policy.

• Ability to organize and prioritize tasks along with multi tasking.

• Ability to work independently with minimal supervision

3/06-4/07: Cannon Cochran Management Services (CCMSI)

Claims Adjuster

• Analyzed and processed Workers’ Compensation Medical/Indemnity Claims.

• Processed complex or technically difficult claims.

• Determined benefits due; made timely payments and adjustments

• Frequently communicated claim activity with claimant and employer

• Obtained job description and discussed modifications for a prompt return to work.

• Interpreted medical reports

• Established and monitored reserve adequacy

• Managed subrogation with third party on claims

• Documented all contacts and outcomes related to case activity in the system

10/99-3/06: Arkansas Municipal League

Claims clerk/adjuster

• Analyzed and processed medical only Workers’ Compensation Claims

• Familiarized with ICD9 and CPT codes

• Familiarized with AR Law and regulations

• Maintained and entered new members into the system

• Maintained annual loss summary reports and report card from the State

• Obtained recorded statements and documented

• Attended continuing education conferences

• Maintained premium billing and created deposits

• Maintained Volunteer Fire Department Income Protection Plan

• Processed and worked month end reports.

Other Education/Training and Skills:

General and Workers’ Compensation Insurance License CSW Training BCBS

Continuing Education, Conferences and Seminars for W/C Business Grammer BCBS

Basics of claims, Ethics, and Medical Terminology classes Filenet Training Health

Advantage

Writing in Business, CPT and ICD9 classes MRR Training Health

Advantage

HAU,IDP, Service Excellence classes Mainframe BCBS/ Health

Advantage

Utilization Review classes how to read edits EBD Reject File Report Project

Microcomputer Applications I class ASUBeebe Amisys Release Testing 6.0

(Microsoft Word, Excel, PowerPoint and Access database) Type 70 WPM

Spreadsheet Applications for Business class ASUBeebe Data Entry

Web Page Design class ASUBeebe 10 Key

Education:

Cabot High School, May 1994, Diploma

Broadway School of Real Estate, November 2001

Arkansas State University Beebe, AR 2010- present

Arkansas Adjusters License for Workers’ Compensation Claims

*Personal and Professional references will be made available upon request

Contact this candidate