Insurance Case Manager Resume
Headline : As an Insurance Case Manager, takes care of the insurance companys clients and help clients decide on the most beneficial policies and ensure clients can benefit from their insurance policies. They also oversee any claims and cases.
Skills : Analytical Skills, Communication Skills.
Description :
- Obtained patient data from referring physician’s office for support of medical necessity and ensures data integrity.
- Reviewed payer medical policy to determine medical necessity based on payer guidelines and/or FDA indications.
- Utilized Insurance Payers principles and requirements to determine coverage for all patients.
- Re-verified insurance prior to each visit for existing patients.
- Obtained initial authorization and reauthorization as applicable.
- Completed the insurance verification in the EMR software and ensures the documentation obtained from the payer’s website is scanned into the patient’s medical record.
- Obtained a Letter of Medical Necessity (LMN), when required, from select payers.
Experience
5-7 Years
Level
Executive
Education
BSc in Health Administration
Insurance Case Manager Resume
Summary : As an Insurance Case Manager, functions as an integral member of a multidisciplinary clinical team which manages the care of patients and verify patients health benefits and coverage for infusion services and obtain authorization as needed.
Skills : Organizational Skills, Interpersonal Skills.
Description :
- Identified and coordinated materials to be sent to the payer for coverage determinations.
- Provided and documented ongoing communication with payer case managers for updates/changes/authorizations.
- Maintained knowledge and proficiency in medical practices through continuing education, staff meetings, workshops, and home study.
- Received and reviewed new insurance applications for missing information like forms, signatures, policy criteria, and prior to submission to the insurance carrier.
- Ordered and reviewed underwriting requirements including Attending Physician Statements, Exams, supplemental forms and other medical requirements for submission to the insurance carrier.
- Conducted regular follow-up via phone primarily and email and/or website, on all outstanding underwriting requirements.
- Organized and prioritized workload to ensure case is processed, issues, and placed in a timely manner while maintaining frequent communication to manage customer expectations appropriately.
Experience
10+ Years
Level
Management
Education
BSW
Associate Insurance Case Manager Resume
Objective : As an Associate Insurance Case Manager, works closely with the clinical staff in coordinating patient care on established patients and ensures accurate and complete verification of insurance benefits.
Skills : Problem-Solving, Attention to Detail.
Description :
- Maintained internal processing database to document work activity and communication on all assigned cases.
- Acted as a conduit for all issues associated with a case to include coordination with all internal departments.
- Responsible for reviewing issued insurance policy for accuracy before mailing to insurance agent.
- Followed up with insurance agents on policy delivery requirements, including application amendments, health statement, insurance premium.
- Ensured policy is placed within specified timeframe.
- Worked collaboratively with fellow staff to advance the values and mission of Futurity First by serving on relevant internal and external committees.
- Assisted with special projects/assignments as requested by members of management.
Experience
0-2 Years
Level
Fresher
Education
BHA
Assistant Insurance Case Manager Resume
Headline : As an Assistant Insurance Case Manager, communicate insurance benefits to include any co-pay or co-insurance to the Patient Account Specialist.
Skills : Time Management and knowledge of Insurance Policies.
Description :
- Responsible for maintaining primary ownership of annuity, life, and senior health cases which requires engaging in frequent communication and coordination between agents, insurance carriers, and internal resources.
- Responsible for setting their agent's expectations appropriately and providing a World Class Customer Service experience, based on our customer's expectations, throughout the service process.
- Facilitated all stages of the underwriting process with clients and Wealth Strategists through various carrier systems and for various insurance products.
- Managed sales force dashboards to comply with department standards, contributing to the achievement of personal and department goals.
- Communicated critical and sensitive underwriting information or problems with Wealth Strategists and clients.
- Worked daily with teammates to accomplish tasks in the underwriting Department while gaining expertise in all processing areas.
- Stayed up to date on state and specific carrier requirements to process business ethically and in compliance.
Experience
5-7 Years
Level
Executive
Education
BHA
Insurance Case Manager Resume
Summary : As an Insurance Case Manager, works closely with clinical staff and Reimbursement team in providing and promoting customer service, process flow, operational integrity, quality care and process improvement along with high service standards.
Skills : Medical Knowledge, Negotiation Skills.
Description :
- Followed up with current clients to gather all necessary information while anticipating future requirements.
- Preemptively resolved client and carrier concerns.
- Responsible for assessing and determining provisional and ongoing liability on claims.
- Coordinated services including medical treatments, recovery, return to work, dispute management, and legal matters.
- Maintained regular and appropriate contact with all parties to determine the injured/ill claimant's progress and possible barriers to progress, or any risks of delayed return to work, recovery, and finalization.
- Regularly reviewed all aspects of the claim, including service provision, appropriate treatment, and adherence to protocols and guidelines.
- Maintained accurate files and ensured deadlines are met.
Experience
7-10 Years
Level
Consultant
Education
BSc in Health Administration
Insurance Case Manager Resume
Headline : As an Insurance Case Manager, work closely with injured workers to assist in the processing of their worker's compensation claim during a challenging time after a workplace accident or injury.
Skills : Insurance Knowledge, Case Management.
Description :
- Responsible for managing and processing claims for injured workers who are claiming reimbursement and cost coverage of various types of medical expenses to help them in their journey to recovery.
- Responsible for reviewing, monitoring and approving requests from your injured workers for medical/surgical treatment.
- Ensured appropriate documentation is received to process weekly wage payments for employers and injured workers.
- Responsible for assessing and processing invoices, entering contact notes, drafting letters relating to decisions being made on claims.
- Responsible for taking and making a high volume of client and customer calls relating to claims outcomes, updates, and customer service.
- Responsible for working closely with internal and external stakeholders including, injured workers, employers, and treating health care providers to support.
- Utilized claims management systems and databases to record and review claims information, ensuring privacy and accuracy of information.
Experience
5-7 Years
Level
Executive
Education
BSc in Health Administration
Insurance Case Manager Resume
Summary : As an Insurance Case Manager, the central point of contact for the injured worker, employer, and any various other treating health providers to process weekly wage payments, support review of requests for medical treatment, ensure correct and timely processing of reimbursement of treatment costs, and be a go-to provider of customer service for any queries we receive from injured workers and employers relating to the processing of their claim.
Skills : Customer Service, Empathy.
Description :
- Answered telephone calls and assisting clients with general and claim related inquiries.
- Communicated professionally, concisely, and consistently to resolve issues and negotiate underwriting offers as appropriate.
- Worked independently and interdependently with other members of their team and with insurance carriers to foster a desired outcome.
- Identified, troubleshot, and resolved problems throughout the case life cycle from submission through policy delivery, and all points in between.
- Embodied an attitude of delivering exceptional client service and relationship management, with the goal of providing an elevated experience for advisors and their clients.
- Reached strong proficiency in using business software programs and other technology.
- Consistently and thoroughly documented all aspects of the insurance cases they touch whether by conversations, emails, or status updates.
Experience
10+ Years
Level
Management
Education
BSW
Insurance Case Manager Resume
Headline : As an Insurance Case Manager, provide crucial return-to-work support for injured workers who are ready to make a return to the workplace.
Skills : Adaptability, Ethics and Integrity.
Description :
- Responsible for working in conjunction with external parties such as medical professionals, treating health providers, occupational rehabilitation services, and employers, and internal teams such as your Injury Management and Technical teams to facilitate and influence a sustainable return to work and life for injured workers.
- Responsible for Participating in Case Conferences and implementing strategies for effective cost management on claims.
- Managed a caseload of insurance claims or cases from initiation to resolution, ensuring timely and accurate processing and adherence to company policies and procedures.
- Served as the primary point of contact for clients, policyholders, beneficiaries, and other stakeholders regarding insurance claims, providing updates, answering inquiries, and addressing concerns.
- Reviewed insurance claims, verifying coverage, assessing eligibility, and determining claim validity based on policy terms, coverage limits, and regulatory requirements.
- Responsible for collecting, organizing, and maintaining accurate records and documentation related to insurance claims, including claim forms, medical records, policy documents, and correspondence.
- Conducted thorough investigations into insurance claims, including gathering evidence, interviewing claimants and witnesses, and collaborating with adjusters, investigators, and legal counsel as needed.
Experience
5-7 Years
Level
Executive
Education
BSW
Insurance Case Manager Resume
Summary : As an Insurance Case Manager, responsible for analyzing claim information, medical reports, and other relevant documents to evaluate claim validity, liability, and potential exposure, as well as assessing damages and calculating claim settlements.
Skills : Teamwork, Risk Assessment.
Description :
- Ensured compliant management of current and ongoing claims within the provisions of the WIRC Act and the non-delegated claims management model.
- Delivered excellent customer service to injured workers and collaborating with the treating doctor.
- Responsible for identifying and assisting in achieving sustainable early Return to Work outcomes.
- Ensured the swift processing of accounts for independent service providers and injured workers
- Determined claims in accordance with delegated limits and legislation and managing claims on an ongoing basis to finalization.
- Participated in Claim Review Meetings and Case Conferencing and prepare up to date summary reports of claims for your client.
- Conducted regular face-to-face case conferences with treating health providers, injured workers, clients and any other relevant stakeholders.
Experience
7-10 Years
Level
Senior
Education
BSW
Insurance Case Manager Resume
Summary : As an Insurance Case Manager, responsible for coordinating medical treatment and rehabilitation services for injured or disabled claimants, working with healthcare providers, case managers, and rehabilitation specialists to facilitate recovery and return-to-work plans.
Skills : Conflict Resolution, Ethical Standards.
Description :
- Negotiated claim settlements with policyholders, claimants, attorneys, and third-party representatives, aiming to reach fair and equitable resolutions while minimizing financial loss and legal exposure.
- Responsible for identifying and investigating potential insurance fraud or abuse, including misrepresentation, exaggeration, or falsification of claim information, and taking appropriate action to mitigate fraud risk.
- Ensured compliance with insurance laws, regulations, and industry standards, including state insurance regulations, HIPAA (Health Insurance Portability and Accountability Act), and other privacy laws.
- Advocated on behalf of clients and policyholders to ensure fair treatment and timely resolution of insurance claims, as well as providing support and guidance throughout the claims process.
- Collaborated with internal teams, including claims adjusters, underwriters, legal counsel, and customer service representatives, to address complex claims issues, share information, and optimize claim outcomes.
- Identified opportunities for process improvements, workflow efficiencies, and customer service enhancements, as well as participated in training, professional development, and quality improvement initiatives.
- Generated reports, metrics, and performance indicators to track claim processing metrics, analyze trends, and measure key performance indicators (KPIs) related to claims management effectiveness and efficiency.
Experience
7-10 Years
Level
Consultant
Education
BHA
