Office Assistant Medical Claims
Resume:
Ama Calagui
Claims Processor II
Sacramento, CA *5811
**********@*******.***
Conscientious business professional with experience in medical claims processing, office administration and retail sales. Personable, team oriented and committed to providing top-quality work to meet company goals.
Authorized to work in the US for any employer
Work Experience
Claims Adjuster
CorrectCare - Integrated Health-Sacramento, CA
May 2014 to Present
Process payment/denial of medical claims, using the WLT claims processing system Assure claims are adjudicated within the designated timeframe Meet productivity and expectations on a daily basis. Respond to customer inquires
Research and request information regarding payment of claims Perform various duties assigned by management
Have professional work ethics
Reliable attendance and punctuality.
Claims Processor II
Zenith American Solutions-Coastwise Claims Office
2012 to 2013
Processes rand rout medical and hospital claims to the correct claim specialist Consistently meets performance standards, including quantity and quality claims processing standards Assist customers with questions and inquiry of claim status Request additional information from providers and members when necessary Current knowledge of assigned Plan(s) and effectively applies knowledge in the payment of claims Assist claims supervisor with special assignments or projects Assists with customer service by responding and documenting telephone/written inquiries regarding eligibility, benefits or claims status; setting up claims to be re-opened; and processing check tracers Claims Examiner
Cigna Corporation
2010 to 2012
Review/process medical claims for occupational, physical therapy, surgery, mental health, and office visits
Utilize product and system knowledge to accurately and efficiently process claims Research and analyze claims accurately to avoid processing errors Insure accurate benefit plan calculations for major medical expenses and deductibles Quality metrics achieved with 98% Financial, 92% Payment, and 93% Procedural accuracy Compliant in meeting guidelines set by quality coaches for questions and coaching Process total claims at 16,802 or 391 claims per week and meet benefit payment requirements within 14 days.
Education
General Education
Merritt College - Oakland, CA
October 2009
High School Diploma in communication
Skyline High School - Oakland, CA
June 1996
Skills
• Microsoft Word (10+ years)
• Microsoft Outlook (10+ years)
• Research
• Analysis skills
• Microsoft Word
• Microsoft Outlook
• Customer service
• Microsoft Office
• Microsoft Excel
• Medical office experience
• Financial services
• CPT coding
• ICD-10
Contact this candidate