Claims Examiner Processing
Resume:
ANNE SANTELMO
CLAIMS EXAMINER
******@*****.***
WORTHINGTON, PA
SUMMARY
Claims Examiner with 12 years of extensive expertise in claims processing, adjustments, and insurance billing. Demonstrates strong organizational, time management, and problem-solving skills, with proficiency in Microsoft Excel and Word. Known for completing high-profile projects efficiently and mentoring team members to enhance operational efficiencies.
SKILLS & ABILITIES
Microsoft Excel Medicaid/Medicare Experience High Profile Projects Microsoft Word Payment Processing Team Oriented
Research Mentoring Employees Time Management
Organization Coordination of Benefits Fast Paced Worker Problem Solving Interpersonal Communication Software Conversion EXPERIENCE
2012-2024 Technical Claims Examiner 2, Pittsburgh, PA UPMC Healthplan
Completed claims processing and adjustments including Commercial, Medicaid, adjustments, and CHC Departments
Completed numerous high profile sensitive Gemini projects that required investigations, attention to detail, quality and strict time frames while following compliance guidelines.
Completed large volume project in CHC Coordination of Benefits
Processed, on average, 80 insurance claims per day.
Processed simple to complex claims including Coordination of Benefits in accordance with company policies and procedures while maintaining production and quality standards.
Adjusted simple to complex previously paid claims after investigation per provider, internal or external inquiry.
Worked directly with supervisor, internal and external customers to resolve requests to satisfaction, relied upon to assist the team in finding improvements and efficiencies.
Worked with leadership researching and explaining how claims process based on HRGs and DRGs explaining the process so they can understand and research further.
Mentored and assisted examiners in training.
Participated in training programs, meetings, and team huddles.
Prioritize and complete all assigned tasks.
Billed all types of insurance including Medicare, Medicaid, Blue Cross, and all others.
Verified insurance and obtain authorizations.
Posted cash payments to patient accounts.
Assisted in new software conversion.
2010-2012 Claims Examiner, Kittanning, PA
Mission Pharmacy
2007-2010 Claims Examiner, Florida
Neogenomics Labs
2003-2007 Claims Examiner, Florida
Option Care of SW Florida
EDUCATION
June 1985 Diploma
Kittanning High School
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