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Cigna Healthspring - Sr Claims Examiner Resume Example

XXXX XXXX XXXXX XXX, PELHAM, NY 10803
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Ph: XXXXXXXXXXXX
Jaxon Turner
Summary
Dedicated and technically skilled business professional with a profound track record of significant claim processing. Versatile administrative support skills developed through experience as a claim examiner, claim auditor, adjustments and appeal coordinator and insurance verifier.
Skills
  • Administration and Management
  • Customer and Personal Service
  • Clerical
  • Active Listening
  • Time Management
  • Complex Problem Solving
  • Active Learning
  • Complex Problem Solving
Experience
Sr. Claims Examiner Jan 2002May 2014 Cigna-HealthSpring Houston, Texas
  • Processed professional claims billed by Primary Care Physicians, Specialty and Ancillary providers while maintaining an overall production of 25 claims per hour and quality of 98% accuracy.
  • As Team Lead, provided training for examiners and new hires as needed while encouraging and recognizing them for a job well done.
  • Worked with coworkers and management team to provide the best customer service for members and providers.
Claims Benefits Specialist Oct 2000Dec 2001 AETNA INSURANCE Sugarland, Texas
  • Responsible for paying claims billed by Primary Care Physicians, Specialty care Physicians.
  • and Ancillary Providers after the system suspends them for information such as updating.
  • Medicare information, continuation of benefits, referrals and precertification.
Claims Examiner Oct 1998Oct 2000 NORTH AMERICAN MEDICAL MANAGEMENT Houston, Texas
  • Responsible for processing claims for Primary Care Physicians, Specialty Care Physicians and Ancillary Providers per the IPA matrix guidelines for assigned IPA.
  • Assist with backlog of all IPA's, attend weekly team meetings while maintaining an overall claims processing accuracy of 98%.
  • On September 28, 1999 promoted to Professional Claims Auditor were duties included auditing 5% of examiner completed claims and assure that errors are corrected, report auditing results to examiners, examiner supervisor and to QA supervisor.
  • Record auditing results into claims accuracy database and investigate and verify overpayment issues to be forwarded to the Refund Coordinator.
Claims Examiner II May 1997Oct 1998 PRUDENTIAL INSURANCE COMPANY Sugar Land, Texas
  • Responsible for paying claims billed by Primary Care Physicians, Specialty Care Physicians.
  • and Ancillary Providers after the claim system suspends them for information such as,.
  • updating Medicare information, continuation of benefits referrals and pre-certification.
Collector Jun 1996May 1997 POLLY RYON MEMORAL HOSPITAL Richmond, Texas
  • Responsible for collection of managed care, commercial, indigent and.
  • workers compensation claims, assisting patients with account inquiries, printing and.
  • mailing letters to patients and insurance companies.
General Office Clerk Jan 2016Jun 1996 BAYLOR COLLEGE OF MEDICINE Houston, Texas
  • Appointment setting, patient charting, telephone techniques and filing.
  • In December of 1994, I worked as a cashier where I checked out patients after their Doctors visit and scheduled return appointments.
  • In September of 1995, I was promoted to Insurance Collector where my duties included collection of Managed care, Worker's compensation, Medicare and Self pay accounts.
Education
Diploma May 1992 National Education Center Houston, Texas Medical Assistant
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Resume Details

This is a real resume for a Sr Claims Examiner in PELHAM, New York with experience working for such companies as Cigna Healthspring, Aetna Insurance, North American Medical Management. This is one of the hundreds of Sr Claims Examiner resumes available on our site for free. Use these resumes as templates to get help creating the best Sr Claims Examiner resume.

Previous Companies:

  • Cigna HealthSpring
  • AETNA INSURANCE
  • NORTH AMERICAN MEDICAL MANAGEMENT

Previous Job Positions:

  • Sr Claims Examiner
  • Claims Benefits Specialist
  • Claims Examiner
  • Claims Examiner II
  • Collector

Schools:

  • National Education Center

Level of Education:

  • Diploma

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