Indian Trail, NC 28079
Seasoned healthcare professional with thorough industry knowledge across various operational positions.
• Over 20 years of Healthcare experience
• Superior knowledge of claims analysis to include ICD10, CPT, HCPCS, and medical terminology
• Complete understanding of healthcare plan design and benefits
• Consistently in top margin for quality
• Strong customer service and problem solving skills
• Able to work both individually and within a team setting with minimal supervision
• High time management and organizational abilities
• Good verbal and written communication skills
• Strong knowledge of Microsoft Office suite and claim adjudication systems Career Experience
Claims Auditor 2012-2017
Key Benefit Administrators Fort Mill, SC
• Performed audits on medical, dental, and vision claims.
• Resolved errors by communicating with Claims Manager or Supervisor.
• Performed audits on eligibility and plan building setup.
• Maintained procedural and financial quality on various departments.
• Adjusted claims for appeals and reviews.
• Ensured compliance with health plan requirements Client Rep/Claims Analyst 2011-2012
• Answered questions and assisted clients with various issues either directly or through one of the senior client managers.
• Interacted daily with clients, vendors, client managers, and operational staff to ensure successful customer service satisfaction.
• Handled inbound and outbound calls from Key Account customers performing a high level of communication and follow up.
• Maintained a growing knowledge of the ever changing healthcare laws to manage clients and optimize their business.
Prior Healthcare Experience
BMS, The Wellness Plan, United Healthcare 1997-2011 Customer Service, Claims Analyst
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