Customer Service Medical
Resume:
Saundra Heet
Beaufort NC 28516
*****@****.***
Motivated former Claim Adjuster with ten years experience in resolution of Bodily Injury
claims and settlement of medical bills with physicians, medical providers, and insurance
companies seeking employment opportunity.
KELLUM LAW FIRM 06/10 TO 09/10
Managed case load of seventy-five active files. Assisted attorney with insurance
negotiations, settlement and prepared files for litigation. Met with new clients and
assessed case value for intake. Coordinated assignment of benefits and payments with
Tricare, Medicare and Medicaid. Researched and located coverage for Bodily Injury,
Medical Payment, Uninsured and Underinsured Motorists claims. Requested medical
bills and records from providers. Drafted legal correspondence and prepared demand
packages to be forwarded to claim adjusters. Familiar with Needles soft ware.
HUMANA HEALTH INSURANCE- CUSTOMER SERVICE 11/09 TO 3/10
Assisted clients with selection and enrollment for Medicare Insurance and prescription
coverage. Processed enrollment applications and payments. Assisted Pharmacies with
processing prescriptions, vacation overrides, special authorizations, and system errors.
Advised physician offices and hospitals on covered procedures. Assisted clients and
fitness centers with supplemental benefits.
HEALTH MANAGEMENT SOLUTIONS- CASE MANAGER 6/09 TO 8/09
Third party recovery for Medicaid in an inbound and outbound call center environment.
Contacted Attorneys and Recipients to verify address information and insurance
information. Set up new claims for contact and sent subrogation letters to all parties.
Contacted Attorneys, Medical providers and Recipients to advise on subrogation and to
discuss payment. Processed checks for payment. Reviewed claims for fraudulent
activities and referred suspect accounts to the State. Set delinquent customer accounts
up for collections process.
ACS - CUSTOMER SERVICE REPRESENTATIVE 9/08 TO 1/09
Provided customer support for ITT Retiree Health and Welfare benefits and 401k in an
inbound and outbound call center. Enrolled retirees for benefits, answered customer
questions on available Health Plans. Advised clients on 401k options and transferred
funds for Retirees. Advised current Employees on qualifications for Hardship loans and
determined eligibility for loans.
GREEN RESCOURCES- CUSTOMER SERVICE REPRESENATIVE 7/08 TO 9/08
Outbound call center contacted students regarding a survey concerning financing of
continuing education for a study sponsored by the Department of Education. Duties
included persuading students to participate in the survey, following a script and data
entry.
NATIONWIDE INSURANCE- BODILY INJURY CLAIMS ADJUSTER 6/02 TO 10/07
Investigate bodily injury and liability claims via scene investigation, police reports,
statements and vehicle photos. Reviewed claims for possible fraudulent activities and
referred claims for further review to SIU department. Contacted Insurance Companies,
Medicare and Medicaid for subrogation purposes. Participated in continuing education
for knowledge of medical terminology and billing practices. Establish reserves and claim
payments within delegated authority. Settle bodily injury claims upon first face-to-face
contact or upon completion of medical treatment. Evaluate medical bills and records to
determine reasonable and customary treatment and negotiate payment with health care
providers. Evaluate demand packages and negotiate settlement with attorneys. Assist and
prepare files for suit, trial or subrogation. Attend mediation with defense council to settle
claim prior to trial. Assist defense council with trial preparation, depositions and monitor
settlement verdict. Maintain current knowledge of court decisions.
PROGRESSIVE INSURANCE- CLAIMS ADJUSTER 11/99 TO 6/02
Inbound and outbound call center environment. Contacted all parties involved in the
accident and determined who was at fault and to rule out fraudulent claims. Coordinated
settlement of total loss vehicles with the claimant and financial institutions. Coordinated
vehicle repairs and rental for claimants and insured drivers. Contacted private Health
Care, Medicare and Medicaid for subrogation purposes. Requested medical bills from
providers, audited medical bills for reasonable and customary treatment and settled
medical payment claims.
EDUCATION
BACHELOR OF ARTS IN BUSINESS AND MANAGEMENT- UNIVERSITY OF
MARYLAND 1993
ASSOCIATE MANAGEMENT STUDIES 1991
Member of Arbitration Forum 6/02 to 10/08
Property and Casualty License 11/99 to 12/08
Notary Public 07/10 to 07/15
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