555 Main Street • Anytown • US 55555 • (555) 555-5555. (555) 555-5555 • email@example.com
Joyce R. Acosta
EXPERIENCE & ACCOMPLISHMENTS
Insurance Claims of ABC Company (’06 to Present)
- comprehensive knowledge of general insurance policy coverage, state regulations, and CPT and ICD9 codes.
- Successfully reduced claims backlog through effective investigation, communication, and follow-up.
- Processed up to twenty-five HCFA and UB92 claims per hour.
- Maintained 100% audit score for six consecutive months.
Insurance Claims with XYZ Corporation (’05 – 2007)
- Resolution of health care insurance claims and communications to all related parties if required or simply requested.
- Validating history, policy and contracts using current applicable guidelines and mandates specific to payment
- Analysis of payments while applying the appropriate reimbursement when due, audits, and assigned , triaging claims to more appropriate sites when necessary.
- Additionally, these skills evolved into serving as a customer service liaison when business needs required.
Insurance Claims with DEF, Incorporated (’02 – 2004)
- Executed initial evaluation of information provided for risk consideration. Utilizing medical dictionaries, underwriting guidelines, and discussed unusual or unfamiliar situations or medical conditions with group underwriter. Calculated rates and prepared proposal and quote packages for agent presentation.
- Screened applications for completeness and eligibility, requested missing information. Reviewed medical conditions listed on applications and claims reports and prepared appropriate medical questionnaires.
- Evaluated renewals for rate adjustment using claims vs. premiums and ongoing medical conditions for review. Identified large claims for underwriter, as well as any re-negotiations, which may occur as a result of the renewal.
- initial billing according to underwriting guidelines, added benefits, employees and prepared paperwork for issuance of group policy. Verifies amounts of initial premium check received and forwarded to the finance department.
- Processed complex group changes for in-force policies following established procedures.
Available upon request
Available upon request