Data Entry Claims Assistant

STATEMENT OF QUALIFICATIONS

Dedicated Insurance professional with more than 20 years of experience in investigating and processing medical insurance claims. Successful track record of handling complicated assignments, analyzing, interpreting policies and negotiating payment solutions. Effectively manage multiple high- priority projects, posting deposits/payments, reconciling accounts with a high degree of accuracy while providing exemplary customer. Offer solid foundation in software applications, database management, and data entry; proven ability to readily master new technology. Dedicated to maintaining strict patient confidentiality. Use this space to provide a brief summary of your qualifications.

PROFESSIONAL HISTORY

Workers Compensate Claims Assistant

CorVel Corporation / 2019 – present

Sets up new claims, processes mail, handles files, and keys notes/dairy entries in the claims system. Processes payments, as needed, processes form letters, state forms and reports. Assists claims examiners with telephone calls including provider, claimant and customer calls. Requires regular and consistent attendance. Provide back-up support to receptionist desk. Additional projects and duties as assigned.

Claims Analysts

Group Benefits Services / 2012 – 2018

Research and resolve check tracer. Resolve provider file checks. Adjudicate voids and recoveries in claims system using departmental procedures. Maintain overpayment records. Assist other departments and team members as needed. Perform miscellaneous project. Assist other departments and team members as needed. Assist with indexing of high dollar claims.

CareFirst BlueCross BlueShield

Claims Examiner II / 1989 – 2010

Analyzed claims to determine the extent of CareFirst BlueCross BlueShield liability, made approval or denial decisions and negotiated settlements with claimants in accordance with policy provisions. Expert in dental claim review. Collaborated with insurance agents and interview claimants to correct errors, rectify omissions and investigate questionable issues.

EDUCATION

Associate Arts Degree, Mass Communications, 1999

Harford Community, Bel Air, MD 21015

Training: Completed extensive training in Medical terminology, Maryland regulations; and customer service delivery.

KEY ADMINISTRATION SKILLS

ICD-9

CPT-10

MS Excel

MS Word

HCBCS

Medical Software

Medical Terminology

Online Claim Submission

Keyboarding

Data Entry (65 WPM)

Medical Insurance

Confidentiality

ACCOMPLISHMENTS

Completed more than 2,500 claims throughout tenure. Provided optimum service to policyholders, negotiated fair settlements and identified fraudulent claims.

Selected by supervisor to assist with file closures resolve complex claims processing issue participate in quality control audits and monitor claim status updates.

Developed a strong understanding of medical insurance policies and legal issues through completion of a series of classes coupled with in department multi-week claims training.

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