Customer Service Insurance

Trena Cooper, PO Box *****, Aurora, CO *****, Mobile 303-***-****,

abjvv5@r.postjobfree.com

Objective

Processing/Adjusting HealthCare insurance claims is where my skills and experience are effectively

utilized for increased efficiency and productivity. Working in a team environment gives me the ability

to work well with others. I have over 10 years of Insurance claims experience.

Professional Work History

September 2009-May 2010, Triage Representive, Kelly Services at BlueCross BlueShield,

Denver, CO

Correspondence reviewer, routing professional and facility claims from an EDI system to the correct

location. Responsible for using a variety of computer programs and investigation tools in order to

distribute threw out the company.

July 2009-Aug 2009, Migration Eligibility Specialist, Insurance Overload Staffing at CIGNA

Healthcare, Denver, CO

Responsible for auditing membership data elements for groups migrating from existing system to

new system. Responsible for loading and clean up of member eligibility into the system as needed.

June 2008-Sept 2008, Claims Processor, Kelly Services at Blue Cross Blue Shield, Denver,

CO

Keys, processes healthcare claims in accordance with claims policies and procedures. Good

understanding of the application of benefit contracts, pricing, processing, policies, procedures,

government regulations, coordination of benefits & healthcare terminology. Good working knowledge

of claims being processed using WGS systems.

Oct 2002-Mar 2008, Claims Processor Sr Associate, CIGNA Government Services,

Nashville, TN

Examines and processes paper claims and electronic claims. Determines whether to return, pend,

deny, adjust or pay claims within policies. Determines steps necessary for adjudication. Follows

established departmental policies and procedures, operating memos and corporate policies to

resolve claims and claims issues. Settles claims with claimants in accordance with policy provisions

Compares claim application and/or provider statement with policy file and other records to evaluate

completeness and validity of claim. Maintaining productivity and quality standards as they are

determines by the business unit; working with other team members and management to continually

identify process improvements within the organization; and cooperating with management and other

business partners to complete task/duties and assigned.

Adjusted claims that needed corrections

Researched cases to make sure corrections where needed

Worked with HCPC codes & ICD-9 codes, 1500 forms

Medicare Part B, Medicare Guidelines

MCS System

Nov 2000-Apr 2002, Provider Network Operations, Focus Healthcare Management,

Franklin TN

Conducts comparison of contract data relative to provider data and/or demographic and

reimbursement data submitted for processing. Assesses the accuracy of provider data processed in

accordance with documented and standard operating policies and procedures.

Jul 1995-Nov 2000, Claims Examiner, CIGNA Healthcare, Nashville TN

Examines and processes paper claims and/or electronic claims. Determines whether to return, pend,

deny or pay claims within policies. Determines steps necessary for adjudication. Follows established

departmental policies and procedures, operating memos and corporate policies to resolve claims

and claim issues. Settles claims with claimants in accordance with policy provisions. Compares claim

application and/or provider statement with policy file and other records to evaluate completeness

and validity of claim. Interacts with agents and claimants by mail or phone to correct claim form

errors or omission and to investigate questionable entries. Typically responsible for independently

reviewing moderately complex claims.

Education

Spokane Falls Community College, Spokane, WA

Accounting

Barnes Business College, Denver, CO

Office Specialist

Accounting

Graduated, Hinkley High School, Aurora, CO

Professional Profile Training

Claims Adjustments

Claims Processing

Express Adjustments

Skills

Microsoft Office (Word, Basic Excel, Outlook & Online)

10-key by touch (11,000 KSPH)

Strong Data Entry

Customer Service

Administrative/Clerical

Excellent organizational skills

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