687 Stoney Lonesome Road
Kingston, PA 18704
Job Objective In search of work as a Claims Processor.
Highlights of Qualifications:
- Substantial experience in medical billing, data processing and claims submission
- Profound knowledge of medical terminology, codes applicable in CPT, ICD-9 and HCPCS systems
- Deep knowledge of benefit plans and processing of medical claims
- Familiarity about universal billing forms and billing processes in electronic system
- Solid understanding of claim processing for healthcare industry
- Proficient with Health Solutions Plus suite of applications and Microsoft Office products
- Ability to respond to customers’ requirements in adherence with company policies
- Ability to complete assigned multiple tasks effectually in changing environment
Centene Corporation, Kingston, PA
August 2007 – Present
- Investigated, verified and processed billing invoice forms provided by transportation provider on time.
- Interacted with transportation providers effectively and efficiently as needed.
- Identified and solved issues related with billing invoice forms from transportation provider.
- Conversed and performed tasks in collaboration with Abuse and Fraud department.
- Identified protocols of claim processing and provided accurate claim policies.
- Adjudicated claims accurately on basis of insurance, benefits included and provider contracts.
- Interacted with clients over phone, email and in person effectively and efficiently.
- Maintained and preserved confidential aspect of claim information effectually.
Retreat Capital Management, Inc., Kingston, PA
May 2004 – July 2007
- Revised process claims to complete estimates resolution.
- Ensured to make payments on estimated completed as prompt as possible.
- Provided assistance to appraisers with details as provided in claims system.
- Complied with customers’ requirement as needed to assure repairs satisfaction.
- Identified and took decision to accept, return, deny or approve claims as per established rules.
- Inspected and processed claims made on paper or electronically.
- Identified steps and stages as required for claim adjudication.
- Complied with set departmental standards, corporate policies and operating memo to solve claims and related issues.
Associate Degree in Business
Gateway Community College, New Haven, CT