KIMBERLY R. TUTSON

*** **** ***** ***** **. Lewisville, Texas 75067

Kim.Tutson68@gmail com

● 15+ years’ experience in ● Strong organizational skills Medical Insurance Benefits ● Dedicated to excellent

● 8+ years’ experience in Commercial Customer service and Works Compensation Insurance ● Data Entry specifically Dealer Open Lot. ● Achieves tasks quickly and efficiently.

● Proficient with Microsoft Office ● Motivated

programs ● Creative and innovative

● Proficient with SalesForce.com

Education:

● Collin College – Plano, TX

Business

Management

● Richland College – Dallas, TX Business

Administration

• Lake Highlands

HS-Graduate

1986

Computer Skills:

● Windows Operating System,

● Software - Microsoft Office - including MS Word, Excel, Power Point, Access, and, Quickens,

● Publisher and Visio

● Ten-key by touch 18,000 SPH, typing 50+ WPM

Work Experience:

Association Healthcare Management

July 2022-April 2023

Claims Analyst II

• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting hospital and physician claims

• Knowledge of International Classification of Diseases (ICD) and/or Current Procedural Terminology (CPT) codes required.

• Data entry and coding

• Reprice bills according to the physician/facility contracts

• Adheres to privacy and confidential and proprietary company policies and procedures

(i.e., HIPAA)

Inficare Staffing April 2021– December

2021-Client

Christus HealthCare (contract

position)

Medical claims processor

• Adjudicate claims at a rate equal to 150 per normal workday

• Maintain statistical accuracy of 98%, and financial accuracy of 98%

• Correct DoD error report as needed

• Respond timely to all Customer Service, Provider Relations type questions

• Other duties as assigned by management

• Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals

• Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

Medical Sunrise System (Contract position) September 2020 – Present

Claims Processor ll

• Enter and process participant reimbursement requests daily in the claims processing system.

• Responsible for processing FSA and HRA claims with a high standard of quality and efficiency.

• Review participants submitted material and determine if it meets applicable guidelines for appropriate reimbursement.

• Track and document daily work tasks/ issues and communicate them with the rest of the team

The Fountain Group (Contract position)

September 2019-December 2019

Collections Loss Prevention

● Enter Late Fees and reimbursements into applicable system.

● Keep all change of address and the do not call information update

● Assign cases to the appropriate departments

Allied Solutions LLC. April 2017- January 2019

Claims Adjuster I/Customer Service Representative

● Investigated and negotiated claims

● Assigned Damage to claims to appraisers

● Determined appropriate application of coverage

● Handled Total loss evaluation process and salvage requirements

● Met deadlines to guidelines of claims

● Claim inquiries

● Customer Service effectively to all claims handled ● Answered incoming email correspondence

US Tech Solutions Arlington, TX April 2015 – Sep 2015 Medical Underwriter (Contract position with Aetna)

• Processed data for the production of rates for small groups.

• Made recommendations for plan changes and rate impact based on financial analysis; developed premium and created financial exhibits.

• Assisted team with projects by collecting data.

Great American Insurance Group - Addison, TX April 2016 – Sep 2016 Claims Adjuster Assistant (Contract position)

● Maked determinations regarding compensability or liability/damage potential on routine cases;

● authorized treatment or initiates other activities on claims, such as contacting outside adjustors or ● investigators

● Set financial reserves for cases; determines temporary disability rates; reviews injury reports to determine

● possibility for third party liability; corresponds with claimants

● Set diary dates for periodic review of case files; and determines which case files can be closed by reviewing files or researching court records.

● Authorized payments and completes necessary claims in order to pay vendors and claimants within prescribed deadlines

● Communicated with departmental representatives, vendors, attorneys, and claimants to clarify facts, correct errors in paperwork, and check on employees' work status or status of unpaid bills

● Reviewed paperwork submitted by claimants for accuracy, completeness, and timeliness

Competed an assignment through IOS

between 2006-2016 in between permanent

positions Medical

Underwriter

● Establishes and maintains relationships to facilitate marketing of products and services to the brokerage community. Made independent sales calls to market and cross market. Reviews and negotiates policy terms and conditions including manuscript wording.

● Underwrote targeted new and renewal business by reviewing and analyzing insured's

(or prospective insured's) loss history, financials, and other pertinent information.

● Performed related duties as requested to include, report preparation, presentations, and special projects to assist in ensuring the success of the product line unit.

● Completed an assignment through IOS at HRAdvance/AON as Customer Care Email

● Specialist. Primary duties included being in receipt of all emails through a dedicated email address, uploading document to the subscribers account, and answering all questions via email, and answer phones as needed regarding the process of the dependent eligibility verification process.

Risk Point, LLC – Dallas, TX. Oct 2013 – Jan 2014

Underwriter Assistant

● Responsible for ensuring the correct technical data on a risk that is inputted.

● Subject matter expert and point person for Binding risk, posting the invoice and processing technical data into Sales Force as well as other on-line formats.

● Followed up for any outstanding information needed to complete the underwriting file.

● Responsible for all endorsement requests and referrals.

● Screened renewals and send out renewal letters.

● Screened renewal applications, performing some of the underwriting on these and prepare the quotes for underwriter approval.

● Responded to underwriter for support and assistance

● Miscellaneous filing on a day to day basis

● Completed project work as assigned by underwriter

● Managed relationships with Producers

● Maintained quality of end product verifying prepared documents follow established procedures

● Have knowledge of and perform computer data entry of quotations, binders and related support documents

● Responsible for the creation of a spreadsheet to record submission ● First point of contact for new and renew business.

HRAdvance/AON Hewitt Associates – Dallas, TX Feb 2009 – Aug 2013

Customer Care Email Specialist

● Primary duties included being in receipt of all emails through a dedicated email address,

● Uploaded document to the subscribers account,

● Answered all questions via email, also answer phones as needed regarding the process of the dependent

eligibility verification process

● Customer Service Representative/Case Installation Representative/ACIS Century Business Solutions – Dallas, TX Oct 2006 – Feb 2009 Benefit Enrollment Specialist. (Contract worker)

● Enrolled employees in their

Medical, Life, and Disability

● Benefits according to the client's specification. Answered all benefit questions regarding the employees plan.

● Added and terminated employees and/or dependents on medical plans due to employment termination or a qualifying event.

● Completed an assignment through IOS at Fort Dearborn Life as Medical

● Underwriter Assistant - handling correspondence for the Sr. Medical Underwriter.

● Once approved or decline, responsible for creating and sending out the approval or denial letter.

● Verify accuracy of billing data and revise any errors.

● Add billing information to the billing systems.

● Contact customers to obtain or relay account information.

● Perform bookkeeping duties, including posting data or keeping other records

● Prepare itemized statements, bills, or invoices and record

● Evaluate possibility of losses due to catastrophe or excessive insurance.

● Review company records to determine amount of insurance in force on single risk or group of closely related risks

United Health Care – Plano, TX Apr 2001 – Aug 2006 Implementation Analyst/ACIS Implementation

Analyst

● Implementation of benefits within Automated Case Installation System, including rates, billing, insuring and eligibility rules for New and renewing business.

● Validated systems therefore member eligibility is feed through legitimate channels.

● Have developed additional skills by assisting Client Service Analyst. Supplementary skills include Case Package setup, Mirror enrollment ordering system and creating Benefit

● Summary by working through Moore Fulfillment.

● Case Installation

● Implemented new business, plan changes and renewals within the Patient Authorization

● Review System. This enables Care Coordination to review and confirm inpatient hospital authorizations.

● Validated systems therefore member eligibility is feed through legitimate channels. ● Secured the Online Processing System to auto adjudicate claims. Created Intranet

● Benefit at a Glance document on behalf of client review and provide as a resource for

● Customer Service Representatives. This document is used as a library resource to quote benefits for inbound calls from members.

● Linked benefit models and SPI to customer specific.

● Defined and build case structure in applicable systems

● American Airline Team Customer Service

● Duties involved, receipt of inbound calls from Members and Providers assisting with issues and resolutions.

● Performed claim audits, Mentored and observed trainees. Mass Group Marketing – Plano, TX Nov 1999 – Sep 2000 Medical Underwriter/Policy Issue Coordinator

● Underwrite disability and life insurance policies for UnumProvident for the Educator Salary

● Protection Plan. The Salary Protection Plan is currently in place in over 475 school districts in more than 20 different states.

● Review insurance applications for eligibility and prepare them for further review by the Senior

● Medical Underwriter at the home office of UnumProvident. Send payroll adjustment letters to schools where employees have been declined and send policies to those who have been approved. Via a database, track all underwriting decisions.

● Be available to answer all policy related questions from agents, payroll departments of school districts, and insured.

Contact this candidate