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Apple Inc - At Home Advisor Resume Example

Lily Sanders
XXXX XXXXXX XXXXXX, Chattanooga, TN 37406
Ph: XXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXX
Summary

Accomplished and energetic Medical Claims Analyst with a solid history of achievement in many aspects of medical insurance. Motivated leader with strong organizational and prioritization abilities. Areas of expertise include claims processing, benefit configuration and customer service.

Seasoned Senior Claims Consultant with more than 12 years of experience in fast-paced medical insurance environment. Excellent computer and software skills. Track record of achieving exceptional results in the medical insurance industry.

Skills
  • Customer and Personal Service
  • Active Listening
  • English Language
  • Reading Comprehension
  • Writing
  • Time Management
  • Critical Thinking
  • Mathematics
  • Judgment and Decision Making
  • Active Learning
  • Complex Problem Solving
  • Computers and Electronics
  • Systems Analysis
  • Systems Evaluation
  • Telecommunications
  • Production and Processing
  • Operations Analysis
  • Programming
  • Technology Design
  • Quality Control Analysis
Experience
At-Home Advisor Apr 2014Present Apple Inc Chattanooga, TN
  • Synthesized data into comprehensive quarterly written reports for management.
  • Effectively managed a high-volume of inbound and outbound customer calls.
  • Addressed and resolved customer product complaints empathetically and professionally.
  • Gathered and verified all required customer information for tracking purposes.
  • Defused volatile customer situations calmly and courteously.
  • Mastery of customer service management systems and databases.
Enrollment Specialist Jan 2014Apr 2014 Dell - State of Massachusetts Affordable Care Act Boston, MA
  • Meet with department heads, managers, supervisors, vendors, and others, to solicit cooperation and resolve problems.
  • Provide users with technical support for computer problems.
  • Evaluate data processing proposals to assess project feasibility and requirements.
  • Enrollment Specialist
  • Collect and enter member data
  • Load plan benefits
  • Enrollment Specialist for the State of Massachusetts 
  • Benefit loads specialist
  • Analysis for The State of Ma onsite 
  • Benefit configuration 
Senior Medical Claims Analyst Mar 2012Apr 2014 Dell Services Round Rock , TX
  • Main Employer
Senior Medical Claims Analysts Mar 2012Dec 2013 Dell - Kaiser Permanente Chattanooga, TN
  • Protect the security of medical records to ensure that confidentiality is maintained.
  • Review records for completeness, accuracy, and compliance with regulations.
  • Enter data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment into computer.
  • Release information to persons or agencies according to regulations.
  • Compile and maintain patients' medical records to document condition and treatment and to provide data for research or cost control and care improvement efforts.
  • Process and prepare business or government forms.
  • Plan, develop, maintain, or operate a variety of health record indexes or storage and retrieval systems to collect, classify, store, or analyze information.
  • Assign the patient to diagnosis-related groups (DRGs), using appropriate computer software.
  • Identify, compile, abstract, and code patient data, using standard classification systems.
  • Resolve or clarify codes or diagnoses with conflicting, missing, or unclear information by consulting with doctors or others or by participating in the coding team's regular meetings.
  • Post medical insurance billings.
SAP Clerk Jan 2011Sep 2011 SAP Chattanooga, TN
  • Recorded numbers of units handled and moved using daily production sheets and work tickets using SAP software
  • Reviewed and analyzed parts inventory for Volkswagen
  • Reviewed processing schedules and production orders concerning inventory requirement 
  • Processed shipments 
  • Trained staff on parts handling processes to reduce shipping times 
  • Verified computations against physical count of stock
  • Operated PC and RF-based computer systems with a high level of accuracy 
  • Monitored parts data and location to identify and avoid potential risks of theft or order errors
  • Used item numbers to properly stock warehouse
  • Attached identifying tags to containers.
Customer Service Representative Dec 2010Jan 2011 T-Mobile Chattanooga, TN
  • Effectively managed a high-volume of inbound and outbound customer calls Addressed and resolved customer cellular product and service complaints empathetically and professionally Gathered and verified all required customer information for tracking purposes Defused volatile customer situations calmly and courteously Accurately documented, researched and resolved customer service issues Mastery of customer service management systems and databases Managed high call volume with tact and professionalism.
Claims Analyst Dec 2009Dec 2010 Cigna Government Services QNXT Nashville Denison, TN TX
  • Reviewed and analyzed medical claims for accuracy
  • Compiled data into written reports for management Reviewed new files to determine current status of injury or illness and develop the proper course of action
  • Reconciled data in collection systems to address discrepancies
  • Isolate the issue, and resolve it.
  • Also known as debugging Identify problems such as benefits loaded incorrectly and error messages 
  • Recorded results and test data 
  • Maintain the provider database for participating and non-participating provider 
  • Update the provider database to allow claims to process
  • Perform other related duties and projects as assigned.
Senior Claims Specialist Oct 2008Nov 2009 Benefits Configuration Denver, CO
  • Anthem BCBS of Colorado 
  • ­ Examine claims processed by other insurance adjusters, for questionable claims to determine whether to authorize or deny payments
  • Enter claim payments 
  • Resolve complex high dollar claims coding and filing issues
  • Maintain claim files and records of settled claims 
  • Verify and analyze benefits used in processing claims to ensure that claims are valid and that payments are made according to benefits and procedures 
  • Backend testing to test the behavior of claims payment database 
  • Verify the data in the database 
  • Verify the constraints 
  • Verify the performance of the procedure 
  • Verify the transactions 
  • Execute triggers for the purpose of verification.
Senior Insurance Consultant-Reimbursement Specia Jan 2006Oct 2008 Blue Cross Blue Shield of TN Chattanooga, TN
  • Validate the information on all claims for data input accuracy 
  • Contact the patients, providers, and other insurance carriers to gain missing information when necessary
  • Use spreadsheets, word processing, calendar, e-mail, and database software to perform work assignments 
  • Approved or denied payments to doctors and other medical providers 
  • Prepared correspondence related to health claims processing.
Customer Service Representative-Claims Processor Feb 2003Jan 2006 Cigna Healthcare iCare, Proclaim, Power MHS Chattanooga, TN
  • Answered a constant flow of customer calls Addressed and resolved customer issues and questions empathetically and professionally Analyze claims to determine approval or denial decisions in accordance with policyholder's coverage Communicate with other insurance companies to coordinate coverage Research and check all claims for accuracy Make necessary adjustments to correct payments made on overpaid and underpaid claims Review information from medical records and documents and translate into the correct HCPCs, ICD -9 and revenue codes General Knowledge of how Medicare and Medicaid applies benefits Provide information to providers regarding patients' claims to assist in office billing accounts.
Benefit Specialist
  • Benefit loads and Analysis for The State of MA onsite Benefit configuration Facets system configuration testing --backend Run SQL queries Verification and update Product Components for Benefit Configurations Benefit enrollment Claims adjuster Claims processor Provider maintenance Loaded provider contracts Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims.
  • Reviewed new files to determine current status of injury claim and to develop a plan of action.
  • Reconciled data in direct collection system with the accounting system to address discrepancies.
  • Substantiated legitimate claims and denied unjustified claims.
Education
Associate of Arts : Graphic Design Apr 2015 Cleveland State Community College Cleveland, TN
GED : Algebra, English, Jan 2000 Chattanooga State Community College Chattanooga, TN
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Resume Details

This is a real resume for a At Home Advisor in Chattanooga, Tennessee with experience working for such companies as Apple Inc, Dell State Of Massachusetts Affordable Care Act, Dell Services. This is one of the hundreds of At Home Advisor resumes available on our site for free. Use these resumes as templates to get help creating the best At Home Advisor resume.

Previous Companies:

  • Apple Inc
  • Dell State of Massachusetts Affordable Care Act
  • Dell Services

Previous Job Positions:

  • At Home Advisor
  • Enrollment Specialist
  • Senior Medical Claims Analyst
  • Senior Medical Claims Analysts
  • SAP Clerk

Schools:

  • Cleveland State Community College
  • Chattanooga State Community College

Level of Education:

  • Associate of Arts
  • GED

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