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Inland Empire Health Plan Rancho - Claims Processor Level 1 Resume Example

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Evelyn Howard
XXXX XXXXXXX XX, PELHAM, NY 10803
XXXXXXXXXXXXXXXXXXXXXXX
Ph: XXXXX XXXXXXXX
Summary
To obtain a career with a progressive organization that will use my education, skills, and abilities in an executive capacity. So that I can effectively contribute to operate in any capacity that best matches my skills and experience.
Skills

Strong interpersonal skills with the ability to get along with others Hard worker, dedicated, conscientious and great with organization Skills Ability to take accurate phone messages and deliver messages promptly Working knowledge of Microsoft windows, Microsoft office word, Microsoft office excel and Microsoft power point, data entry on MS excel spread sheets, working knowledge MS Words, Internet research Skilled in multiple filing methods and copying documents

Experience
Claims Processor Level 1 Aug 2014Dec 2014 Inland Empire Health Plan Rancho CA
  • Retrieve and log claims received by the Health Plan into the data base on a daily basis Verify Member Eligibility and determine the financially responsible entity for each claim received.
  • Communicate with providers on issues related to Health Plan claims procedures, including telephone calls regarding member eligibility, and directing providers where to forward claims for payment Prepare outgoing correspondence for the Claims department including forwarding misdirected mail, additional information requests, and other mailings as needed Interface with other departments, when necessary, regarding claims issues Development and implementation of claims filing and retrieval system Participate in Provider Services Staff Meetings, and other activities as needed Ensured the privacy and security of PHI.
Claims Clerk Sep 2012Mar 2013 CareMore Health Plan Cerritos, CA
  • Set up and maintain records, logs and files.
  • Received, sort, and distributed incoming mail for the department Extracts, sorts, preps, batches and routes documents within the company as needed Made calls to Heath Care Providers to retrieve documents Filed routinely, reported, etc.
  • For others to execute work effort Sorted, labeled, alphabetizes documents/files, etc.
  • for others to execute work effort Ordered all office equipment and office supp lies for the whole department Add new material to file records or create new records as necessary Perform general office duties operating office machines.
Education Intern Aug 2010Oct 2010 Planned Parenthood Pasadena Pasadena, CA
  • Attended on-going trainings in order to update skill and knowledge base Attended staff meetings as required Assist in the design and development of educational materials Co-facilitate education sessions with Education department health educators Distribute flyers and posters; perform outreach activities Serve as a liaison between the clinic and diverse communities Conduct outreach activities to peers and community May provide education in Family Planning clinics Perform other duties as assigned Translated English material into Spanish Emailed clients and staff members.
Youth Program Assistant Jun 2010Aug 2010 L.A WORKS Irwindale, CA
  • Placing youth ages 14-24 with Job Employment Transmit information or documents to customers, using computer, mail, or facsimile machine Schedule appointments, and maintain and update appointment calendar.
  • Analyze data to determine answers to questions from customers or members of the public Provide information about establishment such as location of departments or offices, employees within the organization, or services provided Operate telephone switchboard to answer, screen and forward calls, providing information, taking messages and scheduling appointments Maintaining records of all clients' contacts and servic es used by clients Records were kept manually and through an Internet database system Compile, sort and verify the accuracy of data before it is entered.
Prevention Specialist Sep 2008Sep 2009 Soledad Enrichment Action Inc Los Angeles, CA
  • Worked with High Risk Youth in a school setting Conducted presentation to Parents, teens, and teen parents Instructed classes on STI/HIV/AIDS awareness and Birth control methods Promote responsible parenting Increase community involvement in building healthy families through awareness of the effect of teen and untended pregnancies Keeping Files on Students Up to Date Monthly Reports, by Ethnicity, Race and Age Presented pregnancy prevention curricula in classrooms Facilitated educational and activity groups in community and school settings.
  • Assisted in planning retreats and Events Provided supervision at retreats Collected evaluation data Use internet browser extensively to gather research information Maintained appropriate confidentiality of information Understood and followed policies, procedures, rules, and regulations Communicated respectfully and effectively with clients Developed and utilized strong collaborative relationships with coworkers.
Education
High School Diploma: General Education East Los Angeles College Los Angeles, CA Administration of Justice General Education
Language
Fluent in English/ Spanish {speak, read, write}
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Resume Details

This is a real resume for a Claims Processor Level 1 in PELHAM, New York with experience working for such companies as Inland Empire Health Plan Rancho, Caremore Health Plan, Planned Parenthood Pasadena. This is one of the hundreds of Claims Processor Level 1 resumes available on our site for free. Use these resumes as templates to get help creating the best Claims Processor Level 1 resume.

Previous Companies:

  • Inland Empire Health Plan Rancho
  • CareMore Health Plan
  • Planned Parenthood Pasadena

Previous Job Positions:

  • Claims Processor Level 1
  • Claims Clerk
  • Education Intern
  • Youth Program Assistant
  • Prevention Specialist

Schools:

  • East Los Angeles College

Level of Education:

  • High School Diploma

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