Claim Specialist
Resume:
Shannon M. Schmidt
Indianapolis, IN 46239
E-mail: ***********@*****.***
Objective
To work for a company that allows me to put forth my best effort. To have a job that is both rewarding and challenges me daily. I want to work hard and be rewarded by my own personal acknowledgement of success.
Relevant Experience
I have excellent computer and typing skills. I have experience in answering and transferring calls from multi-line telephones. My skills include handling inbound calls, outbound calls, assisting customers, provider, and co-workers. I am a proficient problem solver. I have worked on large projects and have used pre-created SQL queries. I have experience in medical benefits, claims adjusting, claims processing and problem solving. I also have experience working directly with customers and am familiar with ICD-9 and ICD-10 codes.
Employment History
Key Benefit Administration, Inc., Indianapolis, IN: Claim Specialist (08/2015-02/2017)
As a Claim Specialist, my job duties included assist in all aspects of agent licensing, including auditing,
tracking, follow up, customer service and data entry. I worked directly with brokers and agents to assure the accurate and timely filing of all necessary licensing and paperwork to comply with state law and carrier specific requirements. I also corresponded with brokers, clients (internal/external) and providers on complex claim issues. Researched issues and responded in written form or verbally to the appropriate person. I kept the Manager apprised of issues. Review all appeals and respond appropriately in written format. I also worked CSCLs to maintain a three day or less turnaround times, FAMS and other duties specifically assigned to Claims Specialists. I maintained the performance standard set by the product for accuracy and turnaround times. I provided support to the Claims staff in regards to interpretation of Plan language, benefit structure and procedures. Identified potential training issues and report to Manager and the Training Department. Properly communicated monthly renewals to the team and other internal departments to ensure a smooth renewal. Also, assisted in overseeing the workflow of the team, when applicable.
Anthem Blue Cross and Blue Shield, Indianapolis, IN: Grievance & Appeals Analyst (11/2004-04/2015)
As a Grievance & Appeals Analyst my job duties included reviewing medical records, member benefits, medical policies and sending said information to nurses and doctors for use on appeals decisions. I was responsible for entering doctor’s notes into cases and creating appeal approval or denial letters with a tight time line of five days or less.
Utilization Management Representative (within Anthem)
I was responsible for loading intakes that required precertification from providers and members.
I handled incoming, outbound calls, and written correspondence. I could precert a certain number of outpatient visits. I also managed Continuation of Care documents, on-coming new accounts, and lost accounts that were handled by my unit. I also created spreadsheets to include pivot tables of gathered information. I analyzed claims and situations to determine root cause and resolution.
Multi-Functional Customer Service/Claim processor Representative (within Anthem)
As a Customer Service Rep, I worked directly with customers, providers, and account representatives.
My responsibilities included answering phone calls, researching information and responding as needed, handling written correspondence, as well as processing and claim adjudication.
Claim Processor (within Anthem)
As a claim processor, I processed all incoming claims, linked claims to the appropriate member eligibility file, maintained a production of processing 1,200 claims per week within maintaining a financial accuracy as well as procedural accuracies.
Nora’s Home Cooking and Catering: Assistant Manager/Waitress/Cashier (2000-2004)
My responsibilities included coordinating all schedules to be sent by email or fax, waiting tables, servicing customers. I was also responsible for general cash register duties, assisting with payroll, scheduling, basic filing and handling incoming and outbound calls.
EDUCATION
Northwest High School, Indianapolis IN (1996-2000)
Obtained GED (2000) General education
SKILLS
My communication and interpersonal skills are excellent. I am a fast learner, organized, and very good at multi-tasking. I am self-sufficient and work well on my own or on teams with others. I am very good at communicating with customers as well as other employees within and outside of the business. My business skills include typing, filing, sorting, computing, figuring and processing materials and information. I have proficient written and oral communication skills. I have experience working with Microsoft Outlook, Excel, Word, PowerPoint, Access, Adobe and some SQL. I have experience with compiling information and creating reports with that information. I have research skills and like to problem solve.
References
Eugenia Mitchell, Key Benefit Administration Claim Director 317-***-****
Hester Brodnik, Anthem Blue Cross and Blue Shield Utilization Review Management 317-***-****
Sheri Hagerman, Seven Corners Customer Service Representative 765-***-****
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