Data Entry Medical Claims
Resume:
SULTAN SHAREEF
Anaheim, CA ***** 714-***-**** ******.*******@*****.***
Professional Summary
Experienced Claims Processor/Data Entry Specialist, possessing over a decade of expertise in processing and evaluating medical claims with a strong focus on precision accuracy and adherence to regulation. I'm enthusiastic about joining a dynamic organization where I can contribute accurate and efficient claim processing and data entry.
Professional Skills
Data Entry
10-Key by Touch
Claims Processing
Microsoft Office Suite
Customer Service
Healthcare Experience
Adept Multi-tasker
Administrative Support
Medical Terminology
Organization and Time Management
Employment History
Claims Analyst (Contractor) 11/2023 - 03/2025
Centene Corporation – Remote, CA
Processed institutional and professional medical claims for accuracy and completeness, and investigated any missing data.
Accurately adjudicated medical claims, verifying eligibility, medical necessity, and provider information to ensure proper reimbursement.
Assisted in manually entering 150-200 claims per day.
Reviewed and released pended claims, resolving any discrepancies or issues that arose.
Claims Audit Representative (Contractor) 12/2021 - 07/2023
Employment Development Department (EDD) – Remote, CA
Reviewed and investigated employer separation factors for unemployment insurance cases referred by the State.
Conducted telephone interviews with claimants and employers to gather factual and missing information.
Reviewed fraudulent unemployment insurance claims and assessed wages and earnings for accuracy.
Assisted in the efficient handling of complex claims, ensuring that open, denied, or suspended claims were appropriately addressed and all required line items on forms were completed.
Claims Processor I 05/2015 - 08/2020
Carelon Behavioral Health – Cypress, CA
Performed daily data entry for 150-200 CMS-1500 forms into the claims system, ensuring accurate and timely processing.
Made necessary adjustments to claims by correcting errors and reprocessing claims that were initially denied.
Corrected and adjudicated claims submitted through Electronic Data Interchange (EDI).
Responded to provider inquiries concerning submitted disputes, ensuring prompt and accurate resolution.
Administrative Assistant (Contractor) 10/2013 - 03/2015
Spafax – Orange, CA
Performed clerical duties including procuring office supplies, handling phone calls, greeting clients, and updating purchase orders in the organization's database.
Evaluated content and media components to verify accuracy and authenticity.
Contacted distributors and airline clients via email to verify content authenticity.
Compiled reports using Microsoft Excel to track purchase orders.
Medical Claims Processor (Contractor) 10/2011 - 05/2012
APR Consulting, Inc/Kaiser Permanente – Downey, CA
Processed 100+ Medicare claims daily with exceptional precision.
Verified patient insurance coverage and benefits.
Reprocessed denied claims by collaborating with providers and patients to gather required documentation and resolve issues causing the denial.
Coordinated with other departments to facilitate resolution of claim related issues.
Medical Data Entry Clerk (Contractor) 10/2010 - 04/2011
Aerotek/Anthem Blue Cross – Orange, CA
Handled 150-200 medical claims per day.
Modified customer accounts and made follow-up calls to gather missing information.
Entered data from claim forms, healthcare provider reports, and patient records into Anthem's EHR system or claims management software.
Compiled records of filed and outstanding claims into a spreadsheet.
Accounts Receivable 03/2007 - 01/2009
United Healthcare – Cypress, CA
Reviewed, analyzed, and retrieved outstanding receivables from members' accounts.
Assisted members in resolving account balances by facilitating collection calls and setting up payment arrangements.
Responsible for recording all invoices related to receivables and maintaining accurate aging reports.
Managed 30+ incoming calls daily to resolve overdue accounts.
Education
Business Administration
DeVry University - Long Beach, CA
Computer Science
Fullerton JC - Fullerton, CA
General Studies
Savanna High School - Anaheim, CA
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