North Highlands CA 95660
To be given the opportunity to work as a Claims Examiner for well-established company where my skills can be used to create a good working environment.
Highlights of Qualifications:
- Remarkable experience in reviewing and making determinations regarding medical insurance claims
- Exceptional knowledge of CPT/HCPC and ICD9 coding, procedures and guidelines
- Ability to conduct investigative interviews
- Ability to interpret and apply laws, rules and regulations
- Ability to maintain records, prepare reports and conduct correspondence related to the work
- Ability to obtain and utilize sensitive information discreetly and objectively
Claims Examiner, August 2005 – Present
Sedgwick CMS, Sugar Land, TX
- Processed general liability claims by collecting information to determine liability exposure.
- Assigned reserve values to claims, made claims payments as necessary and settled claims up to designated authority level.
- Managed subrogation of claims and negotiated settlements.
- Ensured claim files are properly documented and claims coding is correct.
Claims Examiner, May 2000 – July 2005
Sedgwick Claims Management Services, Sugar Land, TX
- Reviewed and processed all incoming claims to verify necessary information.
- Entered claim data and information in the computer system.
- Maintained all required documentation of claims examined and claims on hand.
- Preserved confidentiality of all claims files, claims reports and claims-related issues.
High School Diploma, South Fort Myers High School, Fort Myers, FL