Hardworking customer service professional knowledgeable about insurance claims
processes. Seeking a permanent role with room for advancement.
• Excellent sense of direction • Time management
• MS Office • Medical terms and procedure knowledge
• Excellent time management • Health insurance industry knowledge
• Fast learner • Customer service-oriented
• Personable • Organized
• Computer-savvy • Medicare and Medicaid process
CLAIMS EXAMINER 2 01/2009 to 09/2018
United Health Care/March Vision Care - Los Angeles, CA
• Processed complex claims that had been accepted for payment.
• Request and follow up on additional information as needed for incomplete claims.
• Answered calls, emails, and addressing customer inquiries, solving problems.
• Verified patient's accounts for eligibility and benefits.
• Read, interpret and summarize medical contracts/division of responsibility before
allowance of payment.
• Identified claims that were not our financial risk and forwarded to appropriate entity for
• Reviewed claims that were pending and followed through for payment in a timely manner.
• Worked with various fee schedules.
• Maintained a learned knowledge of benefits claim processing, claims principles, medical
terminology and procedures and HIPAA regulations.
• Utilized administrative guidelines as a resource or to answer questions when processing
• 100% audit on claims and other examiners.
• Calculated other insurance and re-pricing benefits
• Completed other production projects as assigned.
MAIL ROOM CLERK 04/2007 to 01/2009
March Vision Care Inc. - Los Angeles, CA
• Picked up incoming mail and delivered materials to designated locations.
• Dropped off outgoing mail/packages.
• Sorted and scanned incoming claims.
• Data entry corrections to scanned claims.
• Receive and load eligibility files.
• Helped the call center answer phones.
• Send emails and faxes.
Palmdale High School - Palmdale, CA High School Diploma