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Peoples Health - Claims Examiner III Resume Example

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XXXX XXXXX XXXX XX, CANA, VA 24317
H: XXXXXXXXXX
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Mason Williams
Professional Summary

Service-oriented Data Entry Specialist with over 10 years background in Health Care. Core competencies include Data Entry, Customer Service and Cash Handling as well as excellent communication and time management skills. Handles tasks with accuracy and efficiency.

Skills
  • Data Entry
  • Customer and Personal Service
  • Successfully completes claims training of category I, II, and Ill pended claims
  • Very good verbal and written communication skills
  • Very good interpersonal skills to interact with personnel at all level
  • Detail-oriented in order to work with a high degree of accuracy and attention to detail to ensure claims are processed correctly.
  • Possesses a professional, positive and energetic demeanor that exhibits support for company goals and policies
  • .Demonstrates a logical thought process in order to interpret and apply contract benefits.
  • Ability to work independently and complete assignments in a timely and accurate manner.
  • Possesses a high degree of confidentiality to support protection of sensitive information.
  • Ability to work a flexible schedule when required
  • Cash Handling
Experience
Claims Examiner III 10/2003 to 06/2006 Peoples Health Kenner, LA Researches and responds to service forms in a clear and concise manner.
Processes category I, II, and Ill pended claims according to CMS's and Peoples Health's policies and procedures utilizing the Amisys Advanced and EXP Macess Doc-Flo systems.
Processes the Claims Review (CRR) and Potential Duplicate reports
Ensures individual production and accuracy benchmarks are met
Operates as a team player to ensure open communication and establishes trust that supports a team environment in the unit.
Assists with maintaining consistent departmental inventory levels.
Reports issues to the Claims Supervisor.
Performs other duties as assigned by the Claims Supervisor or other claims management staff.
Claims Examiner II 01/1996 to 09/2003 Advantage Health Plan New Orleans, LA Researches and responds to service forms in a clear and concise manner
.Processes category I, II, and Ill pended claims according to CMS's and Advantage Health's policies and procedures utilizing the Amisys Advanced and EXP Macess Doc-Flo systems.
Processes the Claims Review (CRR) and Potential Duplicate reports.
Ensures individual production and accuracy benchmarks are met
Operates as a team player to ensure open communication and establishes trust that supports a team environment in the unit.
Assists with maintaining consistent departmental inventory levels.
Reports issues to the Claims Supervisor.
Performs other duties as assigned by the Claims Supervisor or other claims management staff.
Slot Machine Attendant 11/1992 to 12/1995 Harrah's Casino New Orleans, LA Provide change to the players in slot area of the casino.
Make payouts to customers from their winnings at the slot machines.
Accurately handling cash and credit transactions.
Servicing customers in any capacity.
Handled large sums of money per shift.
Reset slot machines when they were tilted.
Balanced drawer after shift ended.
Education
Associate of Science: Medical Coding and Billing 02/2011 Colorado Technical University - Online Colorado Springs, CO
High School Diploma: General Studies 05/1979 Walter L. Cohen High School New Orleans, LA
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Resume Details

This is a real resume for a Claims Examiner III in CANA, Virginia with experience working for such companies as Peoples Health, Advantage Health Plan, Harrahs Casino. This is one of the hundreds of Claims Examiner III resumes available on our site for free. Use these resumes as templates to get help creating the best Claims Examiner III resume.

Previous Companies:

  • Peoples Health
  • Advantage Health Plan
  • Harrahs Casino

Previous Job Positions:

  • Claims Examiner III
  • Claims Examiner II
  • Slot Machine Attendant

Schools:

  • Colorado Technical University - Online
  • Walter L. Cohen High School

Level of Education:

  • Associate of Science
  • High School Diploma

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