Customer Service Medical
Resume:
kathleen m. olson
New Lenox, Illinois 60451
*******@*******.***
SUMMARY
Detail-oriented, well-organized insurance professional with extensive
background in nearly all areas of medical claims, including Medicare.
Background includes claims auditing, training and new account start-ups.
Skilled in coordination of benefits and has a thorough understanding of
medical terminology. Use of Microsoft applications to successfully
accomplish job requirements. Recognized as a quick learner who is willing
to take on additional responsibilities. Known as a personable team player
that also works well individually.
PROFESSIONAL EXPERIENCE
BENEFIT ADMINISTRATIVE SYSTEMS, Homewood, IL 2006 - 2010
Third party benefit administrator
Claim Examiner
Responsible for processing medical, dental and Medicare claims on RIMS
system.
* Ability to work independently and efficiently.
* Adjudicated medical and dental claims, investigated and responded to all
written and telephone inquiries from both members and providers relating
to claims and benefits.
* Successfully handled claims submitted through EDI.
* Evaluate and determine provider and facility contract rates accurately in
relation to the provisions and exclusions of the benefit packages.
* Provided customer service support for Benefit Manager Representatives,
employees and various internal contacts.
* Exceeded production and quality standards of the office.
illinois central hospital association, Tinley Park, IL 1999 to 2006
A not-for-profit organization that provides healthcare benefits for U.S.
employees of the Canadian National Railroad.
Senior Claim Examiner
Responsible for processing medical, dental and Medicare claims on Genelco
system. Extensive experience in EDI (Electronic Data Interchange).
Knowledge of ICD9 and CPT coding.
* Actively participated in establishing and achieving the goals and
objectives of the team.
* Consistently exceeded company guidelines for accuracy and productivity
(99%).
* Implemented coordination of benefits guidelines and maintained employee
records for all railroad employees.
* Successfully handled claims submitted through EDI.
* Ability to work independently and efficiently.
* Provided customer service support for over 7,000 employees and retirees.
* Adjudicated medical and dental claims, investigated and responded to all
written and telephone inquiries from both members and providers relating
to claims and benefits.
dr. peter kahlhammer, Frankfort, IL 2002 to 2005
A dental office with approximately 1,000 patients.
Receptionist (Part-time)
Answered phones, greeted patients and scheduled appointments.
* Accurately and efficiently billed insurance carriers using Practisoft.
* Set up new patient files.
coresource, Matteson, IL 1984 to 1999
Third party benefit administrator.
Traineer/Auditor
Trained current and new employees on claims processing, guidelines and
procedures. Audited all claims examiners.
* Trained newly hired employees on the Claimex computer system.
* Prepared and presented material for scheduled re-training
sessions/workshops.
* Communicated office guidelines and updated benefit information to the
office staff.
* Audited all claims examiners on a weekly basis and provided feedback
based on results to management.
* Retrained staff based on audit results and needs of the office.
* Conducted system demonstrations for prospective clients/broker.
* Coordinated new accounts start-up with the Quality and Sales departments.
Team Leader/Claim Examiner
Assisted the supervisor with daily tasks to determine the critical needs of
the department and also processed medical and dental claims.
* Coordinated staff daily processing requirements.
* Worked with claim examiners to manage mail volume/backlog.
* Processed a high volume of medical, dental and short-term disability
claims using the plan document of the client for benefit determination.
* Exceeded production and quality standards of the office.
* As a member of the Benefit Review Committee; reviewed claim referrals and
questions for benefit determination.
* Assisted manager/supervisor on a daily basis.
* Composed daily claim backlog reports to help determine performance
measures.
EDUCATION
Thornwood High School, South Holland, IL
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