Insurance Claims & Customer Service Specialist

Linda Crocker Insurance Customer Service

Representative

Experience

Receptionist Fine Skin Dermatology, Joliet, Illinois MAR '23 - OCT '23

Medical Claims Adjuster Chicago Laborers Health and Welfare, Westchester, IL JAN '13 - JAN '23

OCT '07 - DEC '12

815-***-**** *********@*******.*** Moncks Corner, SC 29461 Experienced in health insurance claims processing and customer relations, bringing a strong attention to detail and proficiency in systems such as BCBS, Vitech, and AS400 Versatile candidate with vast experience providing outstanding customer service and office support. Proven ability to handle a variety of tasks with accuracy, efficiency, and a high degree of professionalism. Demonstrated expertise in managing front office operations such as greeting visitors, answering phone calls, taking messages, and scheduling appointments.

Signed for incoming deliveries and notified employees of packages. Kept reception and common areas clean and tidy, removing trash and straightening magazines and couches. Maintained detailed and accurate records of visitor requests and of calls received. Handled cash and credit card payments with accuracy. Used sign-in sheets and other check-in procedures to track visitors on premises. Complied with privacy and confidentiality policies when communicating with callers and guests. Received payments and recorded receipts for services. Scheduled appointments and maintained and updated appointment calendars. Maintained tidy, presentable reception area with necessary stationary and materials. Accurate and timely processing of claim payments

Meet department quality and production standards

Data entry for processing

Corresponds with policyholders, customers and co-workers clearly, accurately and professionally Establishes benefits, Coordination of benefits with Medicare and other insurance carriers Conducts basic medical investigations

Reviewed insurance policy coverage to determine validity of patient requests for claims. Communicated with patients by answering questions, providing helpful information and distributing paperwork.

Verified patient information on claims paperwork, checking for and preventing mistakes. Back-up for customer service providing benefits, eligibility, claim status Claims Adjuster Auto Mechanics Health and Welfare, Countryside, IL Sr Claims Adjuster Harrington Benefits Services Inc, Chicago, IL JUL '04 - AUG '07

Claims Adjuster for Individual policies Hallmark Services Inc, Naperville, IL APR '07 - JUL '07

Customer Care Associate II/Claims Processor III Unicare Life & Health Ins, Bolingbrook, IL APR '01 - JUN '04

Sr Claims Examiner Christian Brothers Services, Romeoville, IL FEB '91 - APR '01

Accurate and timely processing of claim payments

Coordination of benefits with Medicare and other insurance carriers Meet department quality and production standards

Conducts basic medical investigations

Handle individual clients request via telephone, e-mail and written correspondence Request over payments from members or providers

Back-up for customer service providing benefits, eligibility, claim status Process out of state claims in two claims systems

Accurate and timely processing of claim payments

Coordination of benefits with Medicare and other insurance carriers Meet department quality and production standards

Establish benefits, Coordination of benefits with Medicare and other insurance carriers Examined claim forms and other records to confirm coverage for loss or damage. Utilized various computer software programs and databases to complete claims analysis. Handle Pre-determination of benefits and send letters of approval or denial Adjusting claims that were processed incorrectly or that were denied for medical records for appeals Gather information to handle appeals from providers or members Request overpayments from providers or members

Incoming call center-duties included answering calls from Members and Providers giving claim status and Medical Benefits

Process group PPO, HMO, Indemnity medical claims along with coordinating benefits with Medicare and other carriers

Adjust claims for additional payment

Request over payments from providers and members

Investigate and resolve complex issues received from providers, clients and escalate issues to manager when encountering barrier to resolving the issue

Conducts basic medical investigations

Accurate and timely processing of claim payments

Meet department quality and production standards

Education

Fox Hill State Girls Home, IL

Home Schooled in grades 9-12

Wilco Area Career Center, IL

JAN '90

certificate in Secretarial and office skills

Skills

Attention to detail BCBS processing system Vitech Systems Star and Russ systems In-house system expertise AS400 proficiency Facets knowledge Computer skills Independent work Prioritization and organization Health insurance claims processing Medical terminology expertise Coding proficiency Data entry skills Production environment experience Scheduling Positive and professional Administrative support PC proficient Calendar management Basic accounting Multi-line phone system operation Scheduling appointments Customer/Client relations Recordkeeping and bookkeeping Front desk operations Professional and polished presentation Phone etiquette Appointment scheduling

References

References available upon request

Corresponds with policyholders, customers and co-workers clearly, accurately and professionally Data entry for processing

Investigate and resolve complex issues received from providers, clients and team members; escalate issues to manager when encountering barrier to resolving the issue Train new employees

Establish benefits, Coordination of benefits with Medicare and other insurance carriers

Contact this candidate