Medical Claims Processing
Resume:
Erikka
Dunmeyer
Champion, PA *****
W: **************@*****.**
m
Skills
• Claims Processing
• Computer Proficiency
• Fraud Detection
• HIPAA Compliance
Professional Summary
Instrumental in handling more than [Number] claims as successful [Job Title]. Accustomed to sorting through large volumes of digital and physical data. Specializes in [Area of expertise].
Capable [Job Title] versed in investigating and processing [Type] claims. Minimize company liability and loss ratios with expert application of claims knowledge. Work within $[Amount] to reach settlements, diligently pursuing and supporting litigation for complex issues.
Experience
Firehouse Lemont Furnace, Pa
April 2017 - January 2019
Bartender
• Created specialty cocktails following complex recipes.
• Set up and maintained appropriate stock levels for bar. Checked identification before serving alcohol to comply with state and federal laws.
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Black Dog Pub Donegol, Pa
February 2017 - February 2020
Head Bartender
• Used proper pour methods to reduce waste and spills. Balanced efficiency with exceptional service to manage guests in high- volume environment.
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Engaged guests with friendly conversation to build bar loyalty and encourage repeat business.
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Cioux Health Arizona
March 2016 - February 2020
Health Insurance Claims Adjudicator
Ensured timely payment of medical claims by maintaining accurate records and submitting claims within required timeframes.
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Performed routine audits of processed claims to ensure accuracy and consistency across team's work output.
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Continually sought opportunities to improve efficiency in medical claims processing workflow through process analysis and suggesting improvements.
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Identified potential fraudulent activities by analyzing patterns in submitted claims data.
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Escalated complex claims disputes or unresolved issues to appropriate management personnel for resolution.
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Reviewed medical claims for accuracy and completeness before submission.
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Monitored changes in payer requirements or reimbursement policies that could impact future claim submissions.
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Education
May 1988
Business
West Mifflin Area High School, West Mifflin, Pa
December 1998
Licensed Practical Nurse
Lenape School of Nursing, Ford City, Pa
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