Insurance Medical Examiner Resume
Are you a Insurance Medical Examiner looking for Insurance Medical Examiner jobs? We have the perfect format and content for your Insurance Medical Examiner resume listed here.
3999 Diane Street
Santa Barbara, CA 93101
(123)-448-4019
r.herrick@emailaddress.com
Job Objective: To secure a position as Insurance Medical Examiner with reputable company seeking energetic and highly motivated employee.
Highlights of Qualifications:
Remarkable healthcare claims processing experience in a managed care environment
Wide knowledge of HMO, PPO, Medicare and Medicaid plans
Familiarity with CPT, HCPC and ICD-9 Codes
Ability to handle complicated claims cases
Ability to analyze claims activity and prepare reports for carriers and management
Ability to investigate claims to determine validity and extent of damage
Proficient with Microsoft Word and Excel
Professional Experience:
Insurance Medical Examiner, August 2005 - Present
WPS Health Insurance, Santa Barbara, CA
Reviewed and processed the complex and technically difficult claims by investigating and collecting information.
Calculated and assigned the timely and appropriate reserve to claim.
Calculated and paid benefits due, approved and made timely claim payments and adjustments and settled claims within designated authority level.
Developed necessary state filings within statutory limits.
Managed the litigation process, ensured timely and cost effective claim resolution.
Assured the claim files are properly compiled and claim coding is correct.
Referred the cases as appropriate to supervisor and management.
Insurance Medical Examiner, May 2000 – July 2005
Kelly Healthcare Resources, Santa Barbara, CA
Processed the claims from start to finish according to certificate terms, complied with internal procedures and state regulations.
Identified the contestable claims for investigation.
Analyzed the application for insurance and verification call when claims are filed for conditions that existed prior to application.
Obtained the Underwriting and Legal opinions prior to proceeding with reformations and rescissions of coverage, procedures are currently in place.
Maintained the timely handling of follow-up requests on suspended claims.
Identified and referred to any suspected Third Party liability claims to Subrogation Analyst.
Education:
Bachelor's Degree in Finance, Albany State University, Albany, GA
