Customer Service Medical

Marcella Marie Marshall

**** ******* ** ************, ************ 19124

***********@*******.*** 267-***-****

Summary:

Highly organized individual with 10+ years of claims processing experience, Strong customer service skills. Proven ability to manage multiple projects while meeting challenging deadlines.

Very detail-oriented, and conscientious self-starter, able to stay calm under pressure.

Flexible and analytical with a keen eye for details.

Work Experience:

UnitedHealth Group

Philadelphia, Pennsylvania

10/2011 - Present

Appeals Reviewer:

Investigate and research member and provider appeals and complaints for self-funded and fully insured accounts.

Document findings in computer. Ensure that all plan exceptions and overturns are processed timely and in compliance with CMS appeals departmental guidelines. Organize case files for external reviews.Generate appeal letters

Process claims adjustments and appeal over turns. As well as handle customer service calls.

BroadPath Healthcare

Philadelphia, Pennsylvania

08/2011 - 10/2011

Medical Claims Processor

Processed and adjusted federal employee medical claims

The Jacobson Group

Plano, Texas

05/2011 - 10/2011

Medical Claims Adjuster

Processed Medicare payments and adjustments. Generate explanation of benefit letters

Keystone Mercy Healthplan

Philadelphia, Pennsylvania

03/2005 - 03/2010

Medical Claims Examiner

Processed medical hospital and physician claims. Audited high dollar claims. Handled claim adjustments. Conduct chair side training. Worked special projects with contracting dept and handled provider calls.

Health Partner Insurance

Philadelphia, Pennsylvania

05/2002-04/2004

Claims Specialist

Adjudicate and adjust medical claims. Worked suspended claims report. Handled provider service calls

Oaktree Health Plan

Philadelphia, Pa

6/1998-12/2001

Claims Team Leader

Adjudicate and adjusted medical claims. Audit high dollar claims. Assigned work queues to Examiners. Test new implementations to claim system. Generate production and claims aging reports. Accompanied contract department to outside meetings. Handled provider service calls.

Oak tree Health Plan

Philadelphia, Pa

04/1997-06/1998

Senior Claims Examiner

Processed medical hospital and physician claims. Handled customer service calls. Worked special projects

EDUCATION

Community College of Phila Philadelphia, Pennsylvania

Associate in Business\still attending

Computer SKILLS

● Microsoft Word, Excel, Access and Internet Explorer. Several of the insurance claims processing systems (Facets, Care planner, Citrix).

Contact this candidate