Sr Claims Adjuster
Resume:
Lydia
Pitts
Ft Mitchell, Alabama *****
W: **********@*****.***
Skills
• Claims investigation
• Case reporting
• Reserve management
• Records review
• Evidence collection
• Good communication
• Problem solving
• Self-starter
• Follow through
• Customer experience control
Professional Summary
Focused Claims Specialist offering over 20 years of claims processing experience. Investigates and verifies data to determine claims adjustment or processing documents all activity in Qcare,WGS and CIW systems. Excellent command of insurance terminology and industry best practices. Experience
Anthem/Bcbs of Georgia Midland, Georgia
January 2000 - June 2021
Sr. Claims Adjuster/Processor
Handled questionable claims by escalating to our Medical Review department.
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Examined claims forms and other records to determine insurance coverage and benefits.
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Paid and processed claims within designated authority level,as a Sr I adjusted both large dollar facility and professional claims daily.
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• Conferred with legal counsel on claims requiring litigation. Documented claims in full, entering payments, reserves and new information.
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• Reported overpayments, underpayments and other irregularities. Made accurate determinations based on information obtained from claimants and medical professionals.
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Maintained records of settled claims and inventory of claims requiring detailed analysis.
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Verified authorizations on previous investigations and questionable claims with more in-depth reviews
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Durable Medical and Chiro Specialist for my department all DME and Chiropractic claims would come to me at one point in the company.
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Worked along with customer service for provider escalations on call immediate adjustments.
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• Coding
• Sweep reports for company.
• Reviewed medical records for appeals.
Education
General education courses
Columbus College, Columbus, Georgia
June 1992
High School Diploma
Carver High School, Columbus, Georgia
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