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Austin Regional Clinic Mediview - Claims Supervisor Resume Example

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Christian Roberts
XXX XXXXXXXXXX XXXXX, Longwood, FL 32750
Ph: XXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXX
Professional Summary:

Accomplished and energetic claims professional with a solid history of achievement in the health insurance industry. Highly motivated self starter with demonstrated ability to set priorities and multi task.  Confident decision maker and effective problem solver able to work independently or as an integral part of a team effort.

Skills:
  • Judgment and Decision Making
  • Complex Problem Solving
  • Quality Control Analysis
  • Exceptional listening and interpersonal communication skills
  • Knowledge of medical terminology, ICD9 and CPT coding
  • Proficiency in Microsoft Office products
Experience:
Claims Supervisor Mar 2013Feb 2014 Austin Regional Clinic - Mediview Austin, TX
  • Provided supervisory support in day to day operations of the claims department and support personnel to include daily monitoring of  production and quality goals, inventory control and worked collaboratively with all internal departments.
  • Performed bi-weekly payroll in the Kronos timekeeping system.  Provided HR functions related to FMLA, employee evaluations, promotions, hiring and training.  Managed attendance and vacation/holiday requests.
  • Provided expertise and customer service support to members, providers and clients and assisted with high level claims issue resolution.
Auditor/Consultant Jul 2005Sep 2011 Towers (Perrin) Watson New York, NY
  • Onsite claims auditor/consultant for claims administration reviews to assess performance in financial, processing and payment accuracies.
  • Audits performed in the following areas:  Medical, Dental, FSA, HSA, Behavioral Health, Customer Service and Eligibility.
  • Responsible for pre-implementation reviews, hospital and physician contract reviews and various special focus audits.
Regional Network Coordinator May 2004Jul 2005 MHNet Austin , TX
  • Recruitment and account management of provider network for this managed care behavioral health organization.
  • Provide in-depth identification and analysis of under served areas in a 10 state region for company expansion and medical necessity.
  • Negotiated facility and provider contracts within the region.
Auditor/Consultant Aug 2002May 2004 Benefit Partners Dallas , TX
  • Auditor for claims administration and operational reviews.  Prepared extensive reports recapping audit detail.
  • Assist clients with assessments of their employee health plan.  Recommendations to clients to assist with improved claims administration performance.
  • Recovery auditing for clients consisting of data analysis of claims information to assist in overpayment recovery.
Community Manager/Financial Adjustment Coordinator Apr 1996Aug 2002 WEB-TPA Irving , TX
  • Supervised medical claims examiners processing self insured group health plans.  Performed staff training, auditing and monitored production.
  • Worked collaboratively with account managers, insurance brokers and human resource personnel to monitor trends and make recommendations for plan design.
  • Developed and maintained Financial Adjustment position to process refunds and overpayments from providers and clients.
Education:
Medical Claims Examiner Certification : Health Insurance Dec 1988 Metro Tech Community College Omaha, NE
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Resume Details

This is a real resume for a Claims Supervisor in Longwood, Florida with experience working for such companies as Austin Regional Clinic Mediview, Towers Perrin Watson, Mhnet. This is one of the hundreds of Claims Supervisor resumes available on our site for free. Use these resumes as templates to get help creating the best Claims Supervisor resume.

Previous Companies:

  • Austin Regional Clinic Mediview
  • Towers Perrin Watson
  • MHNet

Previous Job Positions:

  • Claims Supervisor
  • Auditor
  • Consultant
  • Regional Network Coordinator
  • Community Manager

Schools:

  • Metro Tech Community College

Level of Education:

  • Medical Claims Examiner Certification

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