Claims Experience, and office skills

Location:

Posted:

January 06, 2017

Carol Gierman

Round Rock Tx 78665 Cell : 512-***-****

Objective

I wish to find a challenging career to utilize my investigative skills and claims experience.

Skills

Proficient in claims systems of PACS, Claimtools, Telnet, and Microsoft Word and Excel

Ability to multi-task and work independently

Knowledge of ICD-9 codes, CPT codes and medical terminology

15 years of experience handling disability and medical claims

Ability to professionally communicate claims decisions both verbally and written

Experience

Citizen, Inc, Austin Texas November 2015 - December 2016

Examine claims for life insurance, including aged claims requiring locating of beneficiaries by searching internet and public records

Review claims for approval worked by other examiners before checks issued

Processed hospital confinement, cancer, and accidental death and dismemberment claims

Matrix Absence Management, Austin Texas February 2003 –May 2015

Senior Integrated Claims Examiner

Review, pay and manage disability claims

Review medical records to determine ongoing support of disabling condition

Integrate benefits with Social Security disability and Workers Compensation

Calculate initial benefit payments, overpayment due to offsets, and ongoing benefit

Communicate to claimants benefit status and decisions in both verbal and written format

Interpret plan language for benefit termination, vocational rehabilitation and maximum benefit

Train examiners for long term disability claim management

United Teacher Associates Insurance Company December 1995-January 2003

Senior Claims Examiner, Medical Claims Examiner

Review and pay individual disability and life claims

Review and pay Medicare Supplement and hospital indemnity claims

State Board of Professional Counselors June 1994-December 1995

Word Processing Operator II

Receive and match fees for annual renewal cards and maintain records for audit purposes

Create file for requested materials, provide to requestor with billing invoices of calculated fees

Education

Bachelors of Science from Southwest Texas State University with major in biology 1994

Fundamentals of Life and Health Insurance – LOMA May 1997

Health Insurance Associate – HIAA Spring 2002

References Available Upon Request