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Customer Service Medical

Leesburg, Virginia, United States
April 25, 2019

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Crystal Smith

Medical Claims Analyst

***** ******* *****

Sterling, VA 20165

Cell : 703-***-****

Email :

Analyst with extensive experience in Medical claims processing. Proficiencies include Microsoft and other computer programs which pertain to paying medical insurance policy claims. Quick learning, adaptable individual seeking to contribute extensive data organizational abilities, precision attention to detail and process knowledge to the benefit of a company and its members, clients and vendors. Dedicated and focused; able to prioritize and complete multiple tasks and follow through to achieve project goals. Well-developed interpersonal communication skills to work effectively with people from diverse backgrounds and grow positive relationships with clients and colleagues at all organizational levels. Dependable self-starter seeking to leverage background into a Medical Claims Analyst role with progressive organization. SKILLS :

● Excellent working knowledge of ICD-9, ICD-10, CPT & HCPC coding and billing

● EOBs and Medical terminology.

● Proficient in Microsoft Office Suite, Windows 10, Outlook, Access, Excel & Word.

● Trained in HIPPA & Fraud, Waste & Abuse classes.

● Familiar with Professional Encoder (Optum 360)

● Medicare and crossover along with double coverage training.

● WPM : 50-70

● Telephone customer service


NALC Health Benefit Plan, Ashburn, VA

Medical Claims Analyst

November 15th, 2010 - December 19th, 2018

● Analyze and compute all types of claims with minimum supervision.

● Review and key other plans liability and other information required for processing claims.

● Compose letters using good written communication skills

● Use all tools necessary to obtain information to insure correctness of claims previously processed.

● Use telephone to obtain information from providers, vendors and other outside sources to accurately process claims.

● Perform other related tasks as assigned.

● Initiated various investigations such as pre-existing, accident claims, including possible subrogation and workers compensation, conditions excluded by endorsement and application misrepresentations.

● Requested necessary documents from policyholders, providers and vendors with written and verbal correspondence.

● Reviewed and evaluate medical records, system notes and forms of other various documentation to determine liability.

● Updated system notes to adequately reflect status of investigations.

● Assisted Customer Service in supplying status information & rush requests.

● Demonstrated ability to handle stressful situations. EDUCATION :

Loudoun County High School, Leesburg, VA 1997 - 2001 Degree : GED


Certified Nursing Assistant : (CNA) October 2010

Certified Nursing Assistant

Volunteered for Purcellville Fire & Rescue Department (2010-2011) Training Classes in Loudoun County :

● Bloodborne Pathogens

● Hazardous Materials

● CPR Certified

● Basic EMT

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