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Cuna Mutual Group - Claims Generalist Resume Example

Michael Moore
XXX XXXXXXXX XXXXXX, Bedford, TX 76021
Ph: XXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXX
Professional Summary

Oraganized and motivated Claims Generalist seeking new and challenging rolls within the Claims industry.

Skills
  • Active Listener
  • Customer and Personal Service
  • Critical Thinking
  • Time Management
  • Complex Problem Solving
  • Judgment and Decision Making
  • Subject Matter Expert
  • Detail-Oriented
  • Fast-learner
  • Resourceful and reliable worker
  • Excellent verbal and written communication
  • Adept multi-tasker
  • Composed and professional demeanor
Experience
Claims Generalist Jan 2014Present Cuna Mutual Group Fort Worth, TX

-Review claim files for completeness – use prescribed methods to contact customer for additional information

-Set-up / register new claims; assign claim number

-Analyze claim notification; send claim notifications letters

-May handle routine administrative tasks – mailing, filing, copying

Health Information Specialist Nov 2012Jan 2014 Texas Health Resources Bedford, TX

-Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
-Assisted in the maintenance of medical charts and/or electronic medical record
-Prepared patient charts accurately and neatly
-Proficient utilization of Streamline Health, Access Anywhere, and CareConnect
-Accurately identify and timely resolve account issues/error messages
-Analyze CareConnect and Streamline Health data to ensure that account contains appropriate physician documentation
-Assign missing documentation to the appropriate member of the medical staff for completion
-Placing documentation and or changes to the appropriate account either through scanning, moving or scanned documentation, movement of charges, and/or coordination with clinical record
-Analyze requests for data to determine appropriateness of request
-Manually index documents to provide caregivers with electronic patient information
-Retrieve all discharged medical records from nursing units
-Check medical records received against the discharge logs
-Complete paperwork/reports on any missing medical records
-Prepare medical records and/or report for scanning
-Apply appropriate barcodes as needed to patient records
-Perform quality assurance checks on all medical records/ or reports to verify the accuracy scanned into the system to verify the quality and completion of the imaged record
-Perform chart reviews on medical records to verify completion of patient chart

Data Integrity Specialist Oct 2011Nov 2012 Texas Health Resources-Presbyterian Dallas, TX

Retrieve all discharged Outpatient medical records from nursing units
Complete paperwork/reports on any missing medical records
Prepares medical records and/or reports for scanning
Scan medical records
Manually index documents to provide caregivers with electronic patient information
Assign missing documentation to the appropriate member of the medical staff for completion
Proficient utilization of Streamline Health, Access Anywhere and CareConnect
Analyze CareConnect and Streamline Health data to ensure that account contains appropriate physician documentation
Placing documentation and or changes to the appropriate account either through scanning, moving, or scanned documentation, movement of charges, and/or coordination with clinical record

Call Advisor and Red Brick Health Advocaate Nov 2008Oct 2011 Beryl Health & Red Brick Health Euless, TX

Provide physician referrals, hospital class, seminar or health screen enrollments, appointment scheduling and general hospital information to callers
process credit card payments
Research and correct call management errors and place call backs as needed
Performing physician referrals and general hospital information via Multi-Media methods (Online Chat and E-mails)
As a RedBrick Health Advocating-assisting consumers with questions regarding medical claims, medical plan inquiries and incentives
Assisting with fulfillment for RedBrick Health during peak times of the year

Insurance Form Processor Aug 2003Jan 2006 State National Companies Bedfordq, TX

Updating member's accounts with current insurance documents
Answering loan officers questions about member's accounts
Assisting Account Representatives with reports, cancels and call and confirms
Knowledgeable with Automaintenance, UTL reports and Startrak programs

Education
Bachelor of Arts : Art History Dec 2008 University of Texas at Arlington Arlington, TX
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Resume Details

This is a real resume for a Claims Generalist in Bedford, Texas with experience working for such companies as Cuna Mutual Group, Texas Health Resources, Texas Health Resources Presbyterian. This is one of the hundreds of Claims Generalist resumes available on our site for free. Use these resumes as templates to get help creating the best Claims Generalist resume.

Previous Companies:

  • Cuna Mutual Group
  • Texas Health Resources
  • Texas Health Resources Presbyterian

Previous Job Positions:

  • Claims Generalist
  • Health Information Specialist
  • Data Integrity Specialist
  • Call Advisor and Red Brick Health Advocaate
  • Insurance Form Processor

Schools:

  • University of Texas at Arlington

Level of Education:

  • Bachelor of Arts

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