Claims Coordinator Resume Samples

Description :

1. Review and revise medical leave status report on a daily basis, or as required, ensuring the crew qualifies for ongoing medical leave benefits.
2. Administer medical leave payroll via Solutions to make adjustments as required based on status.
3. Administer the reimbursement of medical and transportation expenses for the crew submitting proper receipts of the cost incurred in connection with the medical leave.
4. Process payments to healthcare, transportation and lodging providers that fall under our clients' maintenance and cure obligation.
5. Update medical leave report and medical leave payroll report Coordinate crew travel with travel coordinators in order to minimize ticket costs, hotel stays and ground transportation costs.
6. Coordinate medical care in the crewmembers home country Liaises with shipboard management to coordinate crewmember's medical leave disembarkation.
7. Coordinate medical paroles in the US for crew receiving care in the US (mainly Miami, Florida) Open and maintain electronic medical leave files Contact and maintain an open line of communication with crewmembers on medical leave.

Experience

0-2 Years

Level

Entry Level

Education

High School Diploma

Description :

1. Helped Design and Implement the tracking of 150,000 tons of steel purchased through Vendors.
2. Researched issues and helped expedite orders when necessary.
3. Participated in the design and implementation of a companywide stocking program for touch up paint.
4. Procured costs with vendor which resulted in immediate costs savings.
5. Assigned incoming claims and monitored processes to ensure timely resolution with vendors for 20 branches nationwide.
6. Negotiated settlement terms with vendors and customers to assure customer satisfaction for claim related issues.
7. Conducted annual Physical Inventories at Vendor locations Traveled and participated in Executive level meetings to negotiate claim resolution with key Vendors such as ArcelorMIttal.

Experience

7-10 Years

Level

Management

Education

Business Management

Description :

1. Responsible for the day-to-day tracking and updating of all claims entered into RMIS including those claims that are forwarded to our third party administrator, Gallagher Bassett.
2. Provide administrative support to Manager of General Liability and Workers' Compensation claims.
3. Effectively works with internal personal, Gallagher Bassett, Mears, and Quanta in providing them information needed in support of both General Liability and Workers' Compensation related claims.
4. Receive and communicate relevant claim information including but not limited to invoices, letters, phone calls, documents, legal notices to the respective Claims Manager.
5. Ensure all reporting from our department is produced on time.
6. Effectively works with internal departments in providing them information needed regarding reporting including but not limited to the weekly report, OSHA related reports, audit related, and Schedule 11.
7. Handles any special projects or assists with miscellaneous duties as assigned.

Experience

5-7 Years

Level

Executive

Education

Business Administration

Description :

1. Possess sufficient clinical knowledge to effectively communicate the medical necessity of treatment with insurance reviewers in order to obtain authorization for treatment services provided for international patients.
2. Communicates the information received to appropriate staff in a timely and efficient manner.
3. Demonstrates understanding of medical terminology.
4. Demonstrates understanding of policy deductibles, co pays, coinsurance and out of pocket maximums, out of network deductions and exclusions.
5. Demonstrates understanding of billing revenue codes CPT and claim forms UB/HCFA.
6. Demonstrates knowledge of diagnosis codes Demonstrates knowledge of EOB interpretation.
7. Requires skill and experience in data entry, ten key, and spreadsheet applications.
8. Communicates effectively with peers and supervisor to address billing and claim issues.

Experience

2-5 Years

Level

Executive

Education

Bachelor's In Marketing

Description :

1. Effectively managed the light duty program and coordinated return to work programs for a company consisting of approximately 300 stores and 10,000 employees.
2. Applied knowledge of worker's compensation practices for PA, MD, VA, WV, OH, and NC.
3. Successfully negotiated and settled claims involved with the company's first outbreak of Salmonella.
4. Coordinated all repairs to vehicles in the company's fleet.
5. Skillfully collaborated with Third Party Administrators, Nurse Case Managers, and legal counsel to minimize lost time and workers compensation expenses, returning the employee to the pre-injury position in a timely manner.
6. Responsible for collections owed to the company due to customers causing property damage to our store locations.
7. Main contact for general liability and food borne illness claims.

Experience

2-5 Years

Level

Junior

Education

Bachelor Of Science

Description :

1. Tactfully created and maintained Access databases to track training information and study trending.
2. Skillfully designed a new lesson plan utilizing PowerPoint and Excel programs.
3. Patiently answered benefit, medical inquiries via telephone, written correspondence or walk-in communications from members, providers, and employers.
4. Efficiently scheduled and coordinated staff, management and departmental meetings.
5. Effectively maneuvered computer systems including Microsoft Office; researching and responding to current/past correspondence or inquiries and documenting all activity in the system.
6. Creatively streamlined processes of multiple departments, cross-trained employees and rolled out corporate initiatives in production, quality and adherence guidelines.
7. Report any safety issues to the Safety Manager and work with the Safety Department on better ways to do things.

Experience

5-7 Years

Level

Executive

Education

Bachelor Of Science

Description :

1. Promoted from clerical position which involved office support duties with increasing levels of responsibility.
2. Trained other personnel on clerical duties, including computer applications.
3. Processed all claims from start to finish.
4. Worked closely with all parties involved while gathering pertinent information.
5. Able to effectively assure new customers of the importance of their claim, putting them at ease.
6. Served as a strong support person to agents in successfully developing a more efficient and cost saving environment for all involved.
7. Developed and implemented a new system for agents by preparing new files with a claims section to speed clarification showing any possible trend of fraud.

Experience

10+ Years

Level

Senior

Education

Diploma In Basic

Description :

1. Prepares Medical records for HEDIS, QARR, HCC, RAF and Star submission.
2. Completes mail merge of all provider correspondence.
3. Compiles all marketing material for provider education and creating hard copy directories and training manual to distribute.
4. Sorts and delivers all claims to the appropriate department for processing.
5. Oversees document management system and scans all documentation in assign folders.
6. Prepare bids and progress reports, as well as other exhibits and appendices as required.
7. Retrieves undeliverable correspondences and research and correct inaccurate information.
8. Works closely with the Marketing Department to develop print ads for Medicare Open Enrollment.

Experience

10+ Years

Level

Senior

Education

Bachelors

Description :

1. Coordinated incoming insurance claims for auditing from Insurance companies for commercial equipment.
2. Worked directly with insurance representatives, there insured, claimants, shops, and all parties evolved.
3. Gathered accident information, quotes for repairs, and photos to confirm damages.
4. Kept all parties informed of the status of the audit and worked with our technicians to get the claims processed in a timely manner.
5. Did all the test pilots accounts for future clients.
6. Crossed trained on all clients and provided back up claims help when departments were short.
7. Attend weekly meetings with members of management to give feedback and areas of concern for pilot accounts.

Experience

10+ Years

Level

Senior

Education

License In Current

Description :

1. Managing large workers compensation accounts in coordination with risk manager.
2. Handle incoming claims calls and preliminary investigation.
3. Work directly with company claim adjusters, claimants and vendors settling claims.
4. Issue claims checks under specific draft authority.
5. Work in field with agents designing claims management systems with clients.
6. Accompany claims adjusters on outside appointments determining coverage and adjusting losses.
7. Proficiency with Applied Systems, Advantage Fax and Real-time Interface Software.
8. Completed the AIC33 course, completed continuing education courses and training for the Claims Supervisor position.

Experience

2-5 Years

Level

Junior

Education

Education

Description :

1. Acknowledge, evaluate, and prioritize incoming injury and liability claims and report of safety violations.
2. Respond to claim needs for accident or injury through investigation processes.
3. Conduct interviews and take witness statements for claims review process.
4. Initiate and schedule all medical treatment.
5. Reduce claims and lost -time costs through thorough record keeping and follow-thru.
6. Coordinate light duty to return-to-work programs.
7. Log, maintain, and analyze reports for processing claims and analysis.
8. Product summary report of all claims processed and claims status.

Experience

7-10 Years

Level

Management

Education

Business Administration

Description :

1. Uploaded new deductions from daily cash sheet to database assigning a claim number, obtained backup information for each new claim.
2. Prepared claims and forwarded to appropriate salesman for approval.
3. Processed all approved claims by entering credits and spreading against debits on customer accounts.
4. Processed customer rebills for denied claims.
5. Determined which claims affected inventory to ensure proper processing.
6. Processed all department credits daily to ensure current customer accounts.
7. Provided instruction to customer and salesman to ensure efficient claim resolution.

Experience

10+ Years

Level

Senior

Education

Diploma