SIU Claims Analyst
Resume:
Melissa Loy
Email: *********@********.***
Address: *** * ** **** *** Apt C304
City: Springfield
State: MO
Zip: 65810
Country: USA
Phone: 620-***-****
Skill Level: Entry
Salary Range: 29
Primary Skills/Experience:
See Resume
Educational Background:
See Resume
Job History / Details:
Melissa Loy
641 W Farm Road 182 Apt C304
Springfield, MO, 65810 United States
*********@********.***
PROFESSIONAL EXPERIENCE
Cox Health Plans Springfield, Missouri United States
SIU Claims Analyst Aug 2006 aii present
ai Requested supporting medical documentation for review
ai Updated eligibility from member submitted yearly cob letters
ai Investigated claims submitted with an accident diagnosis as possible worker's compensation or third party liablity
ai Repriced out of network claims through PCHS, First Health, Multiplan, Viant & HSI for in network benefits
ai Review of potential pre-existing conditions & possible rescissions due to fraudulent member enrollment application
ai Contacted members and providers to continue excellent customer service
ai Proper administration of COB provisions, including benefit determination, dual coverage & Medicare coordination for
regulatory compliance
Great West Inc Fort Scott, Kansas United States
Claims Analyst/Adjustments Jan 2000 aii Aug 2006
ai Analyzed & researched the claim to determine correct payment, pend or denial process
ai Reviewed updated made to reference materials via interoffice memo for compliance of company policy & procedure
ai Applied customer service skills while working on phones to ensure proper payment of claims
ai Verified eligiblity, assigned claim numbers, applied appropriate CPT4/ICD9 coding
ai Processed medical claims in accordance with contract provisions using established policies & procedures
NPC, Inc Pittsburg, Kansas United States
Helpdesk Support Jan 1999 aii Jan 2000
ai Kept invoices & call logs up to date
ai Used a variety of Microsoft applications in daily secretarial work
ai Answered customer service phones for inbound Pizza Hut employees
ai Assisted with technical help via phone for restaurant employees
EDUCATION
PITTSBURG STATE UNIVERSITY Pittsburg, Kansas United States
Bachelor of Science in Human Resources, December 1998
ADDITIONAL SKILLS
ai Proficient in all Microsoft applications, customer service experience, & data entry
641 W Farm Road 182 Apt C304 Springfield, MO, 65810 United States 620-***-**** *********@********.***
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