Medical Specialist Desktop Support

Monica N. Lockhart

*** ***** **** **** *********, AL 35120 Mobile: 205-***-**** ***.******@*****.*** HEALTHCARE INSURANCE PROFESSIONAL

To secure a position in an organization that will allow me the opportunity to leverage my 17 years of claims evaluation and negotiation, customer relationship management, and expertise in the insurance industry into a role that expands my knowledge, professional, and business acumen.

EDUCATIONAL BACKGROUND & CERTIFICATIONS

Property and Casualty Adjuster License (various states) Allstate Insurance (2010 - 2016)

Associate of Arts (Journalism)

Jefferson State Community College (1994 - 1 years of coursework) PROFESSIONAL HISTORY

Allstate Insurance – Birmingham,

Alabama

MedPay Central Medical

Specialist (promotion)

MedPay Central Adjuster

2005-2020

2003-2005

Teletech Corporation – Fairfield,

Alabama

Desktop Support

Technician

2001-2003

Medical Center East, Radiology

Department – Birmingham,

Alabama

Radiology Clerk 1996-2001

~Full job descriptions can be found below~

ABILITY is what you are capable of doing, MOTIVATION determines what you do, ATTITUDE determines how well you do it.

-Lou Holtz

PROFESSIONAL BACKGROUND

MEDPAY CENTRAL MEDICAL SPECIALIST, Allstate Insurance Customer Relationship Management and Claims Evaluation

• Processed approximately 10 motor vehicle accident claims on a daily basis.

• Contacted insured to assess medical condition to include injuries and mental state.

• Advised insured on Allstate Insurance processes and explained coverage information.

• Provided all processing paperwork to insured and assisted in communicating and documenting all complaints, issues, and medical needs for insured’s claim profile.

• Performed 30-day follow-ups on injured parties and kept them abreast of coverage expenditures and pending expense claims.

Medical Coding and Claims Negotiation

• Reviewed extensively all documentation and made coding suggestions and updates based on International Classification Diseases (ICD-9) and Uniform Bill (UB-04) procedures and diagnoses.

• Reviewed medical treatments notes from various medical professionals and processed for payment in Mitchell Billing Platform.

KEY STRENGTHS & SKILLS

Medical Insurance

Medical Coding

Claims Evaluation

Claims Negotiation

NextGen Software

Customer Relationship Management

Strong Communication Skills

New Employee Mentor

Agile Learner

Resilient

Flexible and Adaptable

Team player

Trustworthy

Dependable

Punctual

VOLUNTEER EXPERIENCES

Springville High School Basketball

Booster Club

(2019-present)

Prepares food for approximately 20

players for each game.

Jessie’s Place

(2001-2003)

Served meals to approximately 50

homeless persons twice per week.

HOBBIES & INTERESTS

Writing

Reading

Gym

Basketball

Movie Buff

Spending time with Family

• Reviewed any discrepancies with medical providers and made adjustments as necessary.

• Communicated limits to ensure that insured was aware of all coverage parameters.

• Processed and executed allowable payments for out-of-pocket expenses incurred by insured.

• Performed 60-day follow-ups to evaluate insured’s injury and treatment status and discussed options if additional medical care was needed.

• Summarized medical and treatment care and provided closeout documentation to insured. Leadership, Training, and Employee Development

• Served as acting team lead in supervisor’s absence which included fielding any questions from team members, other departments, and handled all escalated calls.

• Mentored new employees on departmental policies and procedures immediately following onboarding and orientation.

• Served as an employee resource as new trainees got acclimated to medical claims processing. MEDPAY CENTRAL ADJUSTER, Allstate Insurance

• Investigated losses of low to moderate severity to determine cause, scope, and extent of injury and/or liability for potential subrogation.

• Verified coverage and confirmed policy conditions have been met.

• Obtained missing information and ensured data integrity for regulatory reporting.

• Authorized medical treatment for insured.

• Established medical reserves, approved medical bills, and reviewed/requested medical records.

• Documented all correspondence, reports, discussions, and decisions in claim file notes.

• Knowledgeable of multiple state jurisdictions and communicated state policies to insured and forwarded any adjustments to underwriting.

DESKTOP SUPPORT TECHNICIAN, Teletech Corporation

• Assisted and responded to approximately 30 customers and incoming calls per day with computer-related issues as it relates to internet connectivity.

• Prepared tests and applications for monitoring desktop performance and provided performance statistics and reports.

• Summarized client issues and potential solutions within support platform to ensure all internal parties were aware of all client needs.

• Reviewed, analyzed, and troubleshooted various client issues and escalated tickets to various departments to ensure the client’s needs were fully met.

• Attended monthly professional development courses to remain abreast of all software and technological updates.

• Obtained above average ratings for evaluated calls from leadership team. RADIOLOGY CLERK, Medical Center East, Radiology Department

• Established and maintained positive relationship with internal and external customers utilizing service-related techniques including calling members by name, using standard greetings, smiling, communicating expected wait time, and showing empathy.

• Furnished radiology reports and copies of films to doctors for review.

• Provided administrative support for the department such as answering telephone, assisting visitors, and resolving patient inquiries.

• Obtained and documented accurate patient information on forms; always provided patient privacy.

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