620 Florida Adjustor Licensed/Const Field Adjuster/Medical claims
Resume:
Alta Post
***** * *********, *****, ** *****
************@*****.***
EDUCATION: Graduate - Bachelor of Science major in Economics
Colegio de San Juan de Letran, Manila, Philippines
1975 - 1979
Licenses: Active - Florida 620 Adjuster License
WORK EXPERIENCE: Operations Manager
Scott Post Construction, 14320 N Boulevard, Tampa, FL 33613
January 2012 - present
Job Description:
*Investigate the extent of the insurance liability concerning property loss.
*Review property damage and repairs using xactimate.
*Coordinate with home owner’s insurance adjuster regarding payment and settlement on repairs.
*Coordinates hiring and paying subcontractors upon job finish.
*Reviews contracts between contractor, subcontractor and homeowners.
*Prepare all signed documents for submission to procure permits.
*Call inspection departments to call for specific job inspection.
*Manages financial status of the business.
*Understanding of building construction principles
Claim Benefit Specialist
4630 Woodland Corporation Dr., Tampa, FL 33614
April 1997 – October 2011
Job Description:
* Knowledge of medical terminology, diagnosis and medical procedures to process medical claims. Experience in all icd/cpt codes in processing DRG/ domestic/ international and medicare claims.
* Reviews and adjudicates complex, sensitive and specialized claims in accordance with claim processing guidelines.
*Applies medical necessity, complete eligibility, determine coverage, identify discrepancies, and applies all cost containment to assist in the claim adjudication process.
*Proof claim or referral submission to determine review appropriate guidelines, correct provider, claim coding including diagnosis, procedure requirements.
*Performs inpatient and outpatient hospital length of stay, reviews to determine reasonable and necessary care and appropriateness of stay.
*Reviews all medical/surgical billings for reasonable and necessary changes. Examines coding of operative reports, procedures and multiple and complicated surgeries.
*Manage and resolve overpayment and recover of lost customer and company money.
*Responds to questions and letters regarding company’s cost containment program, utilization review decisions and reductions.
*Experience with claims appeals, and adjustments.
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