Insurance Medical

Susan Davis

***** **** ***** **, ******, CO *****

303-***-**** | **********@*****.***

Objective

To establish myself as a valued employee through consistent dedicated efforts, hard work and commitment to exceeding performance expectations.

Experience

Over 5 years experience as a resourceful insurance and warranty claims specialist with a diverse background and an excellent record of success in winning settlements and reducing claims payouts to acceptable and just amounts. Has solid foundation in investigation and settlement of complex medical insurance and warranty claims.

With an overall enhanced skill set that includes multiple years of mortgage loan modification analysis and electronic data management.

Work History

The Warranty Group 2008 – 2010

Claims Adjuster Service Administration

Adjudicated claims for extended warranty service by analyzing and making coverage determinations regarding warranty obligations and coverage. Establish a positive customer relationship while adhering to all business policies so to enhance the company reputation.

Investigated and analyzed documents for accuracy to resolve warranty claims disputes.

Approved or denied claims based on the information given by the contractor, terms and conditions of the warranty and the paperwork provided by the customer.

Set up claims for repair and dispatched repair orders for services.

Processed customer refunds and compensations according to the terms and conditions of the warranty contract.

Educated the customer on policies, procedures and warranties.

Negotiated with outside contractors to provide the best cost possible to the customer and the company.

Specialized Loan Servicing 2005 – 2008

Customer Support Associate / Records Associate

Analyzed and processed requests for loan payoff quotes, verification of mortgage, payment histories, senior and junior lien releases, foreclosures, hardship and short sale requests. Responsible for maintaining 70,000+ customer data base for offsite file storage.

Received, verified and prepared time sensitive material for short sale and hardship packages.

Maintained multiple tracking reports for customer inquires, pipeline and document shipping.

Utilized multiple systems for document back up as well as shipping and requesting documents from file storage vendors.

Apria Healthcare 2003 – 2005

Senior Suspended Biller

Review, research and adjudicated claims to resolve suspended billing reports for a 5 county area working closely with numerous insurance companies and healthcare professionals while meeting and exceeding company ratio goals.

Verified insurance and requested authorizations and prescriptions for medical services.

Prepared, reviewed and processed medical claims for Medicare, Medicaid and 3rd party insurance.

Praxair Healthcare Service 2002 - 2003

Insurance Specialist

Verified insurance for new and existing patients, requested authorizations for Medicaid, Medicare, Colorado Access, Rocky Mountain HMO and various private insurance’s, using appropriate forms, documents and codes.

Processed and approved authorizations and denials for billing.

Reviewed, corrected and adjudicated claims for validation reports.

Arranged and instructed oxygen and durable medical equipment services for newly discharged hospital patients.

Transitioning patients to appropriate DME companies due to insurance criteria and following up with patient or family to ensure patient’s needs were met.

Susan Davis

Other Skills

Knowledge and use of Microsoft programs including, Word, Excel, and Outlook. Experienced in Access and MediSoft. Industry specific training and education in CMS1500, ICD9, CPT & HCPC codes and CMN & PAR’s as well as past education in Medical Terminology, Anatomy & Physiology, Billing and Coding, Clinical Skills, Medical Office Management and business accounting.

Education

Currently enrolled at Red Rocks Community College and will complete the Certificate Program for Medical Office and Billing/Coding 12/2011. Will complete required credits for an Associate Degree of Applied Science in the spring of 2012.

Current GPA of 3.84.

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