Claims Examiner Resume
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2219 Payne Street
Sugar Land, TX 77487
(333)-240-9033
f.roby@emailaddress.com
Job Objective: To be given the opportunity to work as a Claims Examiner for well-established company where my skills can be used to create a good working environment.
Highlights of Qualifications:
Remarkable experience in reviewing and making determinations regarding medical insurance claims
Exceptional knowledge of CPT/HCPC and ICD9 coding, procedures and guidelines
Ability to conduct investigative interviews
Ability to interpret and apply laws, rules and regulations
Ability to maintain records, prepare reports and conduct correspondence related to the work
Ability to obtain and utilize sensitive information discreetly and objectively
Professional Experience:
Claims Examiner, August 2005 - Present
Sedgwick CMS, Sugar Land, TX
Processed general liability claims by collecting information to determine liability exposure.
Assigned reserve values to claims, made claims payments as necessary and settled claims up to designated authority level.
Managed subrogation of claims and negotiated settlements.
Ensured claim files are properly documented and claims coding is correct.
Claims Examiner, May 2000 – July 2005
Sedgwick Claims Management Services, Sugar Land, TX
Reviewed and processed all incoming claims to verify necessary information.
Entered claim data and information in the computer system.
Maintained all required documentation of claims examined and claims on hand.
Preserved confidentiality of all claims files, claims reports and claims-related issues.
Education:
High School Diploma, South Fort Myers High School, Fort Myers, FL
