Team Lead Claims Adjuster
Resume:
Kerry
Cooks
Claim Adjuster
*********@*****.***
Experience
Claims Adjuster II, CareFirst
January 2024- June 14,2024
Reviews and authorizes a full range of claims of a larger scope of responsibility which are unusually complex cases or those of a very sensitive nature involving novel issues, to include any appellate reviews related to contested claims.
Serves as the Team Lead to lower-graded Claim Representatives providing a comprehensive level of technical advice and guidance on complex authorization issues.
Serves as the final signatory with the power to rate and award benefits on claims that are unusually complex, or to terminate, change, or deny benefits.
Analyzes available data which reflects quality levels to determine training needs of lower-graded CSR.
Distributes and balances the workload among the employees in accordance with established workflow and assures timely accomplishment of assigned workload.
Monitors qualitative and quantitative metrics to spot patterns in quality program delivery and pinpoint areas that need more investigation.
Claims Team Lead, John Hopkins Healthcare
March 2019-December 2022
Reviews and authorizes a full range of claims of a larger scope of responsibility which are unusually complex cases or those of a very sensitive nature involving novel issues, to include any appellate reviews related to contested claims.
Serves as the Team Lead to lower-graded Claim Representatives providing a comprehensive level of technical advice and guidance on complex authorization issues.
Serves as the final signatory with the power to rate and award benefits on claims that are unusually complex, or to terminate, change, or deny benefits.
Analyzes available data which reflects quality levels to determine training needs of lower-graded CSR.
Distributes and balances the workload among the employees in accordance with established workflow and assures timely accomplishment of assigned workload.
Claim Adjuster, Jacobson Associates
February 2017- April 2018 Contract
Processing and Adjusting veteran’s medical health claim based on their benefits and eligibility.
Inputting data necessary to generate a form letter describing the decision as to why the procedure was denied or upheld.
Independently assist veterans and their families in the review of the most complex claims problem.
Advised Veterans on how to appeal claims with the necessary documentation.
Education
LeCordon Bleu
Associate degree, Culinary Arts
Skills
Project management Data analysis Communication
Organization Problem-solving Management
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