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Claims Examiner, Auditor, Claim Appeals Analyst

Oakhurst, CA, 93644
$20.00 hr
February 18, 2020

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Sanja M. DAVIS

***** **** ***, ********, ** *****, 559-***-**** cell or

Highly skilled Professional & Lifelong Learner seeking permanent and challenging employment. Particulary interested in a position that would offer possible Tele-Commuting option, either Full or Part-Time


Sierra Valley College - AA Business Administration/Accounting - Fresno CA

Skills Summary:

- Extensive use of Microsoft Office & Adobe Products (Word, Outlook, Excel, Powerpoint, Publisher)

- Medical, Business and Construction Terminologys

- Customer Service/General Office/Claims Examiner & Auditing/QC Skills

- Research/Investigative/Analytical/Problem solving skills

- Excellent Organizational/Multi-tasking Skills.

Employment History:

11/17/14 to PRESENT – Customer Care Representative - Sierra Telephone

Assist customers in person, by email and by phone with various account issues, process payments, record and process returned checks, verify services and answer questions from current and prospective customers. Provide basic troubleshooting for phone and internet issues, answer general question calls, service quotes, ect. Must be able to navigate software systems, read and understand technical information on file, coordinate and work with different departments for service orders, questions and problems. Translate the technical and account information and convey to customers in easy to understand language.

7-19-10 to 11/10/14 – Claims Examiner/Auditor - HealthComp Inc.

Reviewed/released Medical and Dental claims within prescribed guidelines utilizing multiple areas of reference for information while meeting strict quality and production standards.

Audited Medical/Dental claims utilizing multiple areas of reference material while meeting strict quality and production standards. Communicate in a precise and clear manner any error correction instructions to examiners & Team Leads.

4/2009 to 7/19/10 - Project Administrator - River City Staffing Service/Sundt Construction

UC Merced - Social Sciences Maintenance Building.

Provide advanced administrative support to Project Manager, Superintendent and Project Engineers and assisted Sub-Contractors when needed. Also worked closely with UC Merced Facilities personnel to achieve mutual goals.

1/2009 to 4/2009 - Data Transcriber - Internal Revenue Service

Fast/accurate data transcription performed under strict quality standards of 99% or better.

4/2007 to 9/2008 - Project Administrator - Act 1 Personnel/McCarthy Building Company, Inc.

Chukchansi Hotel & Parking Structure Expansion Project

Provided advanced administrative support to Project Manager, Assistant Project Manager, General Superintendent, QCl department, Risk Management/Safety Department as well as general office and payroll duties. Assisted other departments when/where needed.

5/2005 to 01/2007 - Dispatcher/Customer Service - American Claims Services

Provided Customer Service/Dispatcher services to Independent Claims Adjuster Office.

01/2005 to 5/2005 - Insurance Verifier/General Office/Data Entry - Act 1 Personnel

Verifying insurance coverage for patients/data entry in a multi-physician billing group.

5/1995 to 2/2004 - Claims Processor/Appeals Analyst - Aetna Inc.

Medical/Dental claims processor from 1995 to 2000. Appeals/Correspondence analyst from 2000 to 2004. Participated in new software/work-flow testing, input on usage and efficiency. When required, reprocessed claims for additional or corrected benefits.

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