Medical Insurance

Ann Farrel

**** ** *** ******, *** *** Bldg *

Miramar, FL 33025

954-***-**** or Cell 754-***-****

************@****.*** or ***********@****.***

OBJECTIVE:

To obtain a rewarding and challenging position with an opportunity for

rapid advancement.

WORK EXPERIENCE:

AETNA 04/07 - Current)

Claims Analyst (STD Benefit Manager)

Provide timely and effective claim service; handle non-contestable claims;

conduct technical investigation of complex contestable claims, accidental,

and disability claims

arising under life and disability insurance; utilizes standard guidelines

to make claim

decisions; verifies STD coverage, evaluates information received;

calculates, adjusts and pays benefits according to plan or state provision;

identifies other income sources and applies offsets appropriately;

communicates with and educates employees, employers and physicians to set

appropriate expectations both verbally and in writing; documents claim

decisions/actions; enters data into appropriate claim processing systems;

exhibits behaviors outlined in Group STD-Claim Analyst Competencies. 1-2

years experience in a Claims environment. (WAH).

LIVEOPS 01/04 - 01/06 (Independent Contractor)

Virtual Call Center Representative:

Serviced incoming calls working from home selling and upselling a variety

of products seen

daily on television infomercials & commercials, data entry, customer

service.

CIGNA DENTAL 02/03 - 01/04

Dental Reviewer:

Analyzed, researched, examined and processed a high-volume of all specialty

dental claims

(including miscellaneous claims denied for payment) daily, claims were

examined for patient

medical & dental history/records, types of insurance, benefits &

reimbursements. Documented all

important information in Webster (computer application).

FOUNDATION HEALTH (now COVENTRY HEATHCARE) 07/99 - 09/02

Claims Examiner/Processor:

Reviewed, adjudicated, analyzed & processed a high-volume of medical

insurance claims (HCFA

1500/UB92's) in a fast-paced environment, conducted researches to compare

claims payment

against plan benefits and federal mandates, documented important

information, performed data

entry, viewed patient medical history, verified types of insurances &

benefits (attachments), reviewed claims that were denied for payment in

Amisys. Keyed medical information from images on computer screen.

EDUCATION:

North Miami Senior High School

Broward Community College (On-going)

Hilda Tucker Insurance School (All Lines General Insurance)

FastTrain Technical School (Medical Coding/Billing Spec.)

SKILLS:

knowledgeable of STD disability claims, Data Entry, Posting, and Knowledge

of Medical Terminology & ICD-9, CPT, HCPC & UB92's, revenue Coding, Typing,

Filing, Dental & Medical Insurance Claims, Proof Operating, knowledgeable

of Computer Applications.

Office Machines: Typewriter, 10-key Calculator, Pitney Bowes Stamp Machine,

Copier Machine, Office Fax Machine, Computer Terminals, knowledgeable of

Medisoft.

Contact this candidate