Valerie K. Baccus

**** ***** *****

Florence, SC 29501

Phone: 843-***-****

Email: aczcks@r.postjobfree.com

Objective:

To obtain a job in an industry that will enhance my existing knowledge and skills. I have 17 years of experience working on the health insurance side. I am seeking a meaningful and challenging position where my experience and skills will significantly contribute to the overall success of your organization.

Skills:

Microsoft Office

Medical Terminology

Managerial

Customer Service

Cosmetology

Nursing Assistance

Claims Examiner

Employment:

AIG/Pearce & Pearce Administration 2003-2016

Second Pass Adjudicator/Supervisor

Customer Service Representative

First Pass Adjudicator

Pre-Determination /Appeals Department/Correspondence/Adjustments

Interim Claims Manager

Oversea the office to maintain the accuracy of claims and employees ranging from 7-60 employees

Involved in interviewing and testing new hires

Conducted trainings based on the needs determined by personal and company observation

Handling high priority special cases

Reprocessing and/or Adjustments of claims completed on claims with errors or corrections

Maintain daily/weekly production were in accordance per each guideline/policy

Scheduled lunches, breaks, and any special scheduling needs for staff

Kept record of staffs daily work/production

Process payroll biweekly to corporate office

Review all correspondence and respond accordingly as the brochure and policies dictate

Review medical records to make a precise determination for Pre-Determinations

Researching and handling responses to general inquiries, grievances, and appeals

Handling of returned checks/Re-issue checks/Release of checks up to 50K

Review appeal claims for denials to verify if the claim was paid correctly

Processing claims submitted on HCFA 1500, UB92 and itemized billing statements

Answer inbound calls from students and providers and assist with benefit questions and claim status.

Blue Cross Blue Shield 1998-2002

First Pass Adjudicator

Second Pass Adjudicator

Claims Adjudicator III

Processed claims to ensure correct information was used in accordance to coordinating benefits

Answered inbound calls from clients concerning claim payments or benefits information

Reviewed all correspondence to adjust any necessary claim benefits

Education:

Wilson High School (1989-1993)

Graduated

Kenneth Schuler School of Cosmetology

(2011-2013)

Limestone College

Currently Attending

References Available Upon Request

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