Jeanine Chambers

Valley Stream, NY *****

ad3egm@r.postjobfree.com

+1-718-***-****

15+ years of experience resolving complex claims including No-Fault personal injury cases, medical billing review and analysis of case information for settlement strategy and defense. Looking to utilize my skills in customer service, investigation, multi system use and medical management among others obtained.

Authorized to work in the US for any employer

Work Experience

Customer Service Representative

Brighton Health Plan Solutions/ Magnacare - Garden City, NY January 2022 to Present

• Handle inbound calls from physician, hospitals and medical providers.

• Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.

• Adjust claims requiring minor steps to reprocess accurately.

• Listen attentively to customer needs and concerns and offer solutions.

• Answer questions on fee schedules, network participation and general requirements.

• Meet customer requirements through first contact resolution.

• Knowledge of CPT codes and ICD-9

• Communicate through multiple channels of voice, email and chat

• Handle non-routine and non standard issues that require problem solving.

• Provide concierge service to members requesting medical equipment orders. No-Fault PIP Litigation Specialist

GEICO - Woodbury, NY

October 2015 to September 2019

• Investigate, evaluate, settle and/or defend first party PIP suits.

• Researched and gathered information related to cases in order to write up defense letters.

• Review litigation materials including depositions and expert's reports.

• Prepare and present written/oral reports to senior management setting forth all issues influencing evaluation and recommending reserves

• Analyze coverage, liability and damages for purposes of assessing and recommending reserves

• Negotiated and Issued award and settlement payments.

• Contact with attorneys to discuss case files and attempt to resolve matters.

• Thoroughly reviewed billing for bundling, upcoding, etc as part of special investigation of fraud.

• Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from the insured, counsel and senior management regarding claims No-Fault Personal Injury Protection Claims Examiner GEICO - Woodbury, NY

October 2008 to October 2015

• Medically and financially managed motor vehicle accident claims involving injured parties with value ranges from $10,000 up to $50,000 dollars

• Advised injured parties of their benefits and Status of the medical claim or lost wage claim including Workers Compensation wage reimbursement.

• Review medical billing, ICD-9/ICD-10 codes and procedure codes for payment and/or independent peer review.

• Processing medical claims in accordance to policy benefits, New York State and HIPAA regulations

• Worked as part of special Investigation Unit to identify fraudulent accident claims. Education

Bachelor's in Business

York College - New York, NY

January 2003 to June 2007

Skills

• Microsoft office

• Excellent multi tasking skill (10+ years)

• Excellent communicating skills (10+ years)

• Ability to learn new systems fast (10+ years)

• Time management (10+ years)

• Communication skills (10+ years)

• Negotiation

• Keyboarding proficient (10+ years)

• Medical Billing

• Medical Terminology

• ICD-9

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