840 Woodbridge Lane
Detroit, MI 48219
Job Objective Seeking work as a Medical Claims Examiner where my expertise can be utilized to their fullest potential to help company meet short and long-term goals.
Highlights of Qualifications:
- Remarkable experience in processing medical claims
- Good understanding of medical terminology, HCPCS, PDR , CPT and ICD-9 codes
- Extensive knowledge of appropriate health insurance principles
- Thorough knowledge of subrogation, reinsurance, workman compensation, third party liability and coordination of benefits claims
- Ability to analyze claims, set reserves, determine compensability and settle claims
- Ability to resolve difficulties quickly
- Ability to make decisions and institute change when appropriate
Medical Claims Examiner, August 2005 – Present
Apollo Health Street, Detroit, MI
- Adjudicated medical and dental claims.
- Processed all types of pended claims.
- Handled customer service calls for both medical and dental claims status and coverage questions.
- Handled provider demographic up-dates to claims system.
Medical Claims Examiner, May 2000 – July 2005
Aerotek, Detroit, MI
- Examined, data enter, calculated and adjudicated insurance claims complying with federal, state and county laws, plan policy and company procedures.
- Entered codes and verified data for computer processing.
- Maintained individual production count.
- Updated and maintained policy manual timely.
Bachelor’s Degree in Business Administration, Northern Michigan University, Marquette, MI