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WebTPA previously Waterstone Benefits Admin - Claims Examiner Resume Example

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Levi Perez
XXXX X XXXXXXXXX XX, Oklahoma City, OK 73122
XXXXXXXXXXXXXXX
Ph: XXXXXXXXXXXX
Professional Summary

Responsible Insurance Claims Examiner proficient in claims processing and adjudication and coordination of benefits for medical groups. Passionate and motivated, with a drive for excellence. Six years in the health insurance industry and numerous years in accounts receivable and customer service positions.

Skills
  • Claims Processing
  • Medical CPT Coding and ICD-9
  • Dental ICA-ADA-CDT
  • Medical Terminology
  • Data Entry and 10-key
  • Microsoft Office
  • Accounts Receivable
  • Team Player
  • Dependable
  • Self Motivated
Experience
WebTPA (previously Waterstone Benefits Admin) Oklahoma City, Ok Claims Examiner Oct 2012Present
  • Claim Processing Hospital, Medical, Dental claims in a timely manner
  • Review and understand plan documents for various medical groups
  • Proficient at CPT, ICD-9, HCPS Coding
  • Knowledge of Cobra and HIPPA rules and regulations
  • Experience with the Affordable Care Act regulation
  • Coordination of Benefits with numerous medical plans

  • Customer Service experience

  • Familiarity of Microsoft Office programs

Waterstone Benefits Administrators Oklahoma City, OK Provider Maintenance Jan 2008Oct 2012
  • Data Entry of Providers and Networks
  • Verify W-9s with IRS and load information to system
  • Research returned 1099's from Providers
  • PPO Pricing
  • Pricing claims for first Health and PHCS
  • Organization of provider and network files
  • Customer Service with numerous providers

Homeland Grocery Stores* Bethany, OK Receiving Manager Jan 2007Jan 2008
  • Maintain all accounts receivable for all 13 departments
  • Daily shipping and receiving
  • Monitored inventory control reports for all 13 departments
  • Training for all new receiving personnel and new department managers
  • Compliance training for all equipment
Albertson LLC* Bethany, OK Receiving Manager Jan 1992Jan 2007
  • Maintain all accounts receivable for all 13 departments
  • Daily shipping and receiving
  • Monitored inventory control reports for all 13 departments
  • Division and local training for all new receiving personnel and new department managers
  • Compliance training for all equipment
  • Jewel Osco/Skaggs Alpha Beta* Bethany , OK Receiving Clerk Jan 1981Jan 1992
  • Maintain all accounts receivable for all 13 departments
  • Daily shipping and receiving
  • Assistant of cosmetic department

  • Education
    Northwest Classen High School Oklahoma City, ok GED Computer classes Canadian Valley Vo-Tech -2008 GED Test , Oscar Rose College 1992
    Bethany Beauty College Instructors License-1978
    Special Training:
    Fraud and Abuse for Medical Claims
    Ethic and Compliance training
    Privacy and Security Training
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    Resume Details

    This is a real resume for a Claims Examiner in Oklahoma City, Oklahoma with experience working for such companies as Webtpa Previously Waterstone Benefits Admin, Waterstone Benefits Administrators, Homeland Grocery Stores. This is one of the hundreds of Claims Examiner resumes available on our site for free. Use these resumes as templates to get help creating the best Claims Examiner resume.

    Previous Companies:

    • WebTPA previously Waterstone Benefits Admin
    • Waterstone Benefits Administrators
    • Homeland Grocery Stores

    Previous Job Positions:

    • Claims Examiner
    • Provider Maintenance
    • Receiving Manager
    • Receiving Clerk

    Schools:

    • Northwest Classen High School

    Level of Education:

    • GED

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