Customer Service Insurance

Jessica Raskin

**** ** ***** *******, *******, FL 33323

Cell: 954-***-****

***********@*****.***

Objective

Auditor with a strong background in the Health Industry and extensive knowledge in Workers’ Compensation,

and Commercial Insurance, seeking a full time position with substantial challenge and growth potential.

Summary of Qualifications

Health Audit/Insurance: COB's,CPT/HCPCS/ICD-9, UB04, EOB's,HIPAA Compliance

Health contract review, client invoicing, Audit recovery

Creating, executing, and reviewing payroll reports to ensure accuracy of client information.

Workers’ Compensation Insurance: Exemptions, and ADP reports, UCT6, 941, 943, 1099, 1096, W-2,

Payroll journals,General Ledgers,Profit and Loss statements

Computer Proficiency: Microsoft Word-Advanced, Excel-Intermediate Level (Macro's Pivot Tables, etc),

Power Point, PK, CPR+

Type 65 wpm

Bilingual, Spanish both written and oral

Professional Experience

Scio Health Analytics, Miramar

6/2011-Present HCD Auditor II

Functional Responsibilities include identifying files to be audited through a query process then performing an

extensive review on each file/ account to determine if correct payments were made to the patient’s insurance

company along with review revenue codes, diagnosis and procedure codes to determine audit candidacy. Also,

review provider contracts/fee schedules, etc. to determine correct payment methodology and then accurately re-

price claims accordingly. Once file is reviewed and correctly processed, all audit findings must be documented.

Auditors must also evaluate current procedures for efficiency and accuracy and recommend solutions for process

improvements and future training necessity. As a HCD Auditor, we must also assist in the selection process by

supporting the audit process from the point of new client implementation through loading of selected claims and

overseeing inventory to ensure work is being finalized according to program policy.

CDR Associates, LLC, Miramar

3/2007 5/2011 Health Auditor/Patient Recovery Analyst

Responsible for the identification, analysis and recovery of overpaid healthcare accounts for various healthcare

providers. Assisting hospitals in South Florida in creating efficiencies to reduce their credit balances through the

use of proprietary software. As a Staff Auditor, we are expected to have thorough knowledge of hospital

computerized accounting systems, experience with multiple claim reimbursement environments (per diem, DRG,

percentage of charges, etc.) and an ability to work with providers in a professional and constructive manner.

L&L Auditing Services, Coral Springs

9/2006-3/2007 Internal Audit Reviewer

Performing internal premium audits for Automobile Liability, Commercial, General Liability and Workers

Compensation Insurance. Completing all audits according to manual rules and receiving them thru state-of-the-art

technology available in the industry. Processing all audits in a timely fashion by utilizing electronic file

transmission for audit requests and activity status updates.

Jessica Raskin

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Amtrust, Boca Raton – 1/1998 – 9/2006

9/2001-9/2006 Internal Premium Auditing Analyst II

Processing all premium audit statements according to Florida laws and statutes. Ensuring all premium audits

processed are in accordance with Florida Statutes and rules promulgated by the Florida Department of Labor, the

Florida Department of Insurance, and the state’s regulatory bureau relative to classifications, rates/rating plans,

and basis of premium accurately and on a timely basis. Obtaining payroll information from clients who are

required to disclose accurate payroll annually. Assisting with all disputes from Agents, Insured’s and CPA firms

filtered in thru email, phone or fax. Working with field audit companies and/or payroll companies on a daily

basis. Researching and acquiring information through the National Council on Compensation Insurance for risk

assessment and the Department of Labor and Department of Insurance in order to obtain all current business

status and exemptions.

6/2000-9/2001 Internal Premium Audit Analyst I

Process all Voluntary audits that are received with incomplete payroll records. The procedure involves phoning

the agent or insured to properly complete the audit and/or triple billing or forward to the Analyst II to process and

analyze all final voluntary audits.

6/1999-6/2000 Underwriting Assistant

As an Underwriting Assistant, I assisted the Underwriter in the following: Deciding which risks are acceptable,

determining the premium to be charged and the terms and conditions of the insurance contract along with

monitoring those decisions. I reviewed the application and input all the information in the Underwriting quote

system. I also reviewed all incoming mail and revised address changes and officer information. In addition,

attended telephone courtesy classes and Excellent Customer Service seminars.

1/1998-6/1999 Loss Control Clerk

Assist in developing written policies and process electronically transmitted reports. I provide assistance to our

outside Loss Control Consultants for the whole state of Florida. I create, receive and assign safety inspections on

a daily basis along with input accurate data for Large Accounts over 100,000 dollars. Additionally, I attended

Underwriting classes.

Education

Associates Degree, International Relations 12/2004

Broward Community College - North Campus

References

Ms. Tammy Tesauro

Mrs. Carmen Turner

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