Claims Adjuster /Quality Analyst
Resume:
Callie O’Roy
Linda, CA *****
Cell 916-***-****
Email: ********@*****.***
Dear Sir/Madame:
I am seeking a position that will allow me to utilize my professional medical office skills as well as my management, administrative, and analytical skills to contribute to a positive medical claim work environment. I am a great motivator who thrives on positive results. I am dedicated to harmonizing in diverse teams and I push to achieve individual and group success.
I look forward to discussing my qualifications with you further in the course of a professional interview. Sincerely,
Callie O’Roy
Callie E. O’Roy
7829 Golden Ring Way
Antelope, California 95843
Email: ********@*****.***
Objective: Interested in securing a position that will enable me to continue to mature professionally, while utilizing my management; medical claims work experience, and administrative skills to contribute a positive work environment. Clinical Qualifications
Claims Adjuster (Medical, Dental, Vision)
ICD-9/10 Coding
Risk Management
Claims Auditor
Client/Staff Education
Quickbooks Desktop Pro
Employment History
2018 – Present
Versant Health
Rancho Cordova, California
Position: Senior Claims Audit Specialist
• Analyze and review medical, and routine vision claims for accuracy, completeness, and eligibility.
• Reviews claims for eligibility to be reimbursed
• Maintains updated records and prepares required documentation performance guarantee monthly reporting
• Verifiy and audit all aspects of the claims adjudication process
• Ensure the accuracy of benefit configuration, provider records and fee schedules; plan benefits, reimbursement rates and reimbursement payments.
2018-2018
1 Solution Staffing
NAACP, Sacramento, California
Position: Professional Office Specialist
Serving as primary administrative support duties included:
• Primary contact for telephone coverage and greeting guest.
• Using professional and technical skills for the benefit of the organization
• Maintain Business Center, make copies, send and retrieve faxes
• Oversee the maintenance and operations of the all center equipment
• Responsible for the assembly of all mass mailers 2014-2017
Fireman’s Fund, Sacramento, California
Position: Future Medical Examiner
• Serve medical insurance customers by determining insurance coverage
• Examine and resolve medical claims; document actions; maintaining quality customer services; ensuring legal compliance.
• Determines covered medical insurance losses by studying provisions of policy or certificate.
• Establishes proof of loss conducting 3 point contacts for AOE/COE
• Documents medical claims actions by completing forms, reports, logs, and records.
• Resolves medical claims by approving or denying medical treatment; enforcing Utilization Review and IMR’s, calculating benefit due; initiating payment or composing objection/denial letters. 2013-2018
Ingress Property Ventures LLC
Position: Owner/CEO
Self-employed purchased rehabilitated and sold real estate at market value
• Purchased properties
• Rehabilitated properties
• Maintained properties
• Sold properties
Education
• A.A. in Computer Science, MTI College, Sacramento, California
• B.A. in Computer Science, University of Phoenix, Sacramento, California (In progress) Callie E. O’Roy
7829 Golden Ring Way
Antelope, California 95843
Email: ********@*****.***
References
DeWana L. Hale
Antelope, CA 95843
*************@*****.***
Katrice D. Hurd
Antelope, CA 95843
************@*****.***
Chantel L. De’Lay
Salinas, CA 93901
******@*****************.***
RELATIVE POSITIONS HELD
1980-1982: Computer Science Corporation – Claims Clerk 1982-1986: Crown Life Insurance – Claims Adjuster
1987-1989: Pacific Presbyterian Medical Center – Claims Manager 1989- 1991: Vision Service Plan – Special Claims Supervisor 1991-1993: HealthNet – Claims Adjuster (Kenda Temp Agency) 1992-1997: SEIU Local 588/Retail Clerks – High Risk Claims Auditor/Adjuster 1997-1998: Mercy Health Care/Catholic Healthcare West – Claims Manager/Consultant 1998-2001: Health Plan of America – Claims Adjuster 2001-2004: Western Health Advantage – Disease Analysis Specialist
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