Claims Adjuster Data Entry

KERRYANN NELSON

845-***-**** Newburgh, NY, ***** ******@***.***

SUMMARY

Experienced Claims Adjuster with over 10 years of experience in the insurance industry. Adept in reviewing and analyzing claim files to ensure accuracy and compliance with insurance policies. Possess strong communication skills and an ability to work independently and collaboratively.

PROFESSIONAL SKILLS

Issues Handling Complaint Handling/Processing

Excellent Phone Etiquette Problem Solving

Attentiveness Microsoft Office

Multi-Tasking Compliance Reporting

Data Updating PC Proficient

Data Entry Calendar & Docketing

Scheduling Computer Proficiency

Data Updating

WORK EXPERIENCE

Medical Claims Adjuster Jul 2023 - Present

United Healthcare Eden Prairie, MN

Developed and maintained strong relationships with healthcare providers to expedite the claims process.

Utilized claim management software to enhance processing efficiency and accuracy.

Demonstrated robust conflict resolution skills while managing escalated claims issues.

Resolved complex billing issues for clients, ensuring positive relationships and high retention rate.

Evaluated and processed medical claims to ensure accurate billing and reimbursement.

Investigated discrepancies by verifying patient information, medical records, and provider details.

Maintained comprehensive records in compliance with regulatory requirements, industry standards, and current medical billing codes.

Health Care Aide Jun 2018 – Mar 2024

Community Home Care Service Central Valley, NY

Provided personal care services to improve quality of life for patients.

Assisted patients with mobility needs, increasing their independence and overall well-being.

Assisted with wound care, dialysis, and other medical procedures.

Monitored vital signs regularly to identify changes in health status and address issues promptly.

Provided compassionate care to patient i home-care setting.

Collaborated with healthcare team to improve patient outcomes and treatment plans.

Organized medical supplies and equipment to streamline workflow and optimize efficiency in patient care delivery.

Maintained accurate and updated patient records

Assisted in transporting patients to medical appointments.

Assisted with daily living activities, such as meal preparation and household chore, to promote a healthy and comfortable environment.

Medical Claim Representative Feb 2013 – Jul 2023

United Healthcare Eden Prairie, MN

Updated patient records and insurance information with 94% accuracy.

Evaluated and process incoming medical claims for accuracy, ensuring that all required documentation and billing codes are correctly applied.

Confirm patient information, treatment details, and medical billing codes by cross referencing medical records.

Investigated denied or disputed claims, determining the cause of issues.

Participate in continuous training and professional development to remains current with industry trends and regulatory updates.

Maintained a high level of customer service and patient satisfaction.

Resolved 96.5% of patient claims accuracy and effectively and in a timely manner.

Maintained accurate and up-to-date patient records in compliance with HIPAA regulations.

Maintained confidentiality of patient information in accordance with HIPAA regulations.

Participated in regular staff meetings to discuss patient service improvement initiatives.

Processed payments and credits for patient accounts using appropriate software.

Utilized medical office software to manage patient accounts and insurance information.

Human Resources Assistant Mar 2008 – Jun 2012 Wingate at Beacon Beacon, NY

Conducted background checks to ensure compliance with hiring standards.

Monitored and tracked license renewals for candidates to ensure timely updates,

Assisted with new hire on-boarding by preparing orientation materials and organizing paperwork.

Verified candidates' license status with New York Board to confirm active or expired status.

Managed employee records, including personnel files and other confidential documents.

Updated employee records in the HR database and ensured accuracy of information.

Prepared and reviewed job postings for open positions.

Coordinated employee training and development activities.

CNA Mar 2008 - Jan 2012

Wingate at Beacon Beacon, NY

Assisted with patient transfers to and from wheelchairs, beds, and stretchers.

Assisted with bed positioning and turning to prevent skin breakdown.

Ensured that resident rooms were kept clean and sanitary.

Assisted with patient's personal hygiene and grooming.

Developed and maintained positive working relationships with residents and their families.

Observed and reported changes in resident behavior or condition to the supervisor.

Monitored vital signs and reported changes to the nursing staff.

Assisted with daily activities, including bathing, dressing, grooming, and mobility support.

Provided compassionate care and emotional support to patients and families.

Assisted nurses and medical staff with patient care and documentation.

Maintained a clean, safe, and organized environment for patients.

Ensured patient dignity and privacy while delivering high quality care.

EDUCATION

28 Credits: Pre-Nursing

Jun 1996

Orange County Community College, Middletown, NY

High School Diploma: General Studies

Jun 1993

Newburgh Free Academy, Newburgh, NY

REFERENCES

References available upon request

Contact this candidate