Insurance Specialist Resume Samples

Description :

1. Ensures accurate insurance benefit determinations through active investigation.
2. Consistently initiates pre-certification when required and notifies the Financial Counselor when coverage issues arise.
3. Positive, effective communications with interrelated areas assuring prompt follow up and courteous reception.
4. Maintains quality performance and productivity standards.
5. Positive, well-organized and capable of motivating others to positive outcomes.
6. Verify accounts for accuracy to ensure that the correct codes are entered to avoid and reduce claim denials.
7. Patient Accounts Specialist IV Responsible for collecting co-pays, ensure claims are processed timely, register patients, verify insurance, investigate claims and problem solve, float from various departments, post charges, interact with internal and external customers.

Experience

10+ Years

Level

Senior

Education

Diploma

Description :

1. Perform insurance deduction activities for personnel and reconcile data printouts.
2. Coordinate personnel actions with payroll deductions and data processing for insurance deductions.
3. Compile data and prepare various reports relative to insurance benefits.
4. Receive, screen and direct incoming telephone calls and walk-ins; answer questions regarding benefit coverage, costs and payroll information as necessary.
5. Update and maintain employee files regarding changes in benefits and employment as necessary.
6. Maintain and process various insurance billings and distribute insurance materials to staff and department supervisors.
7. Maintain and update payroll files and records of a confidential nature with insurance emphasis, COBRA, TEFRA and leaves of absences.
8. Process and maintain records of staff leaves and absences.

Experience

10+ Years

Level

Senior

Education

BS In Business Administration

Description :

1. Designed and implemented programs for personnel.
2. Conducted educational presentations geared toward increased productivity.
3. Utilized presentation software and incorporated Power Point presentations.
4. Developed training manuals, presentations and videos on numerous topics.
5. Designed and conducted surveys of instructors, managers and participants.
6. Researched best practices and used them in all training programs.
7. Aligned new learning development and solutions with the company's strategic goals.
8. Responsible for corporate and consumer sales and account management.

Experience

2-5 Years

Level

Junior

Education

Bachelor Of Arts

Description :

1. Audited hearing aid claims for quality and accuracy prior to submission.
2. Reviewed and handled claim rejections in Healthfusion from payer rejections to claim submission errors, as well as audited transmissions to ensure claims had been received by payer.
3. Provided claim report analysis researching billing issues, and escalated billing issue resolution and patient account accuracy.
4. Served as a liaison for all communication with the Sonus and Miracle Ear corporate and franchise clinic staff and franchise owners.
5. Conducted quality reviews of billing staff daily work.
6. Utilized operation tools to provide leadership that ensured growth and development.
7. Developed, designed, and implemented department policies and procedures.
8. Provided reimbursement analysis for codes and procedures company was billing for.

Experience

7-10 Years

Level

Management

Education

BS In ECONOMICS AND MATHEMATICS

Description :

1. Provided quotes for home and auto, personal and commercial, insurance from a variety companies to best suit the customer's needs.
2. Prepared bank deposit and controlled cash box.
3. Processed payments, analyzed, evaluated, and managed changes to existing policies and maintained verbal and written correspondence with clientele and represented insurance companies.
4. Maintained and organized the physical and electronic files.
5. Trained staff on specialized company databases used to hold active or recently active policies and on the company software used for quoting a client's insurance costs.
6. Completed software updates and database back up.
7. Worked with database designer to troubleshoot and implement corrective procedures required to support the working process and improve efficiency.

Experience

0-2 Years

Level

Entry Level

Education

Bachelor's In Computer Science

Description :

1. Procure and disburse homeowner's, flood, wind and optional insurance renewals, with an average number of disbursements per day of 10-15.
2. Research discrepancies with insurance bills to maintain consistency of system information.
3. Research and resolve unmatched disbursements that are rejected by the system for payment.
4. Monitor insurance expiration reports and follow up on any missing bills.
5. Review and process insurance losses from member, According to company guidelines Process requests from members or credit unions to drop private mortgage insurance coverage.
6. Track loans with force placed insurance coverage.
7. Process incoming tasks from the Member Service Department, Follow up on premiums to be paid to insurance companies, also questions related to Private Mortgage Insurance,(PMI), determining if it was still required on the mortgage.
8. Research and resolve Flood insurance requirement issues.

Experience

2-5 Years

Level

Junior

Education

Insurance

Description :

1. Purchased all equipment, supplies and services for the college, from qualified vendors and according to applicable purchasing laws.
2. Edited and processed incoming purchase orders.
3. Organized the bidding process in accordance with state purchasing laws.
4. Helped prepare specifications, advertised for bids, arranged pre-bid conferences, bid openings and prepared bids for Board approval.
5. Coordinated interior design of College facilities, such as furniture purchases for offices, meeting rooms, and classrooms, carpet and window treatment selections, and paint color choices; and consulted with vendors.
6. Completed various insurance renewal processes; maintained files for general insurance coverages and claims and contacted insurance broker regarding claims and inquiries.
7. Coordinated special events such as annual Black History Month celebration and Support Staff United Way Silent Auction.
8. Served on various internal committees such as Cabinet, Strategic Planning and Policy Committee.

Experience

10+ Years

Level

Senior

Education

Diploma

Description :

1. Managed high call volume with tact and professionalism.
2. Prepared reports and communication for senior management and clients.
3. Referred unresolved customer grievances to designated departments for further investigation.
4. Prepared reports and communication for senior management and clients.
5. Managed high call volume with tact and professionalism.
6. Acted professionally and patiently when addressing negative customer feedback.
7. Modeled exceptional customer service skills and appropriate diagnostic sales techniques.

Experience

2-5 Years

Level

Junior

Education

Bachelor Of Science

Description :

1. Managed all release of information processing recipient health information case files to perform data analysis and profiling to determine recovery opportunities from fraudulent, abusive or erroneous claim payment and reported activities.
2. Extract and analyze data for data modeling and the development of detailed metrics.
3. Build and maintain a database, electronic spreadsheets, data analysis, metrics and management reports primarily through Excel, Access and SQL.
4. Initiate accurate records and maintain records in a confidential, secure, complete, and accessible manner for future recipient oversight.
5. Coordination of record delivery, contracting multiple coordination of record and billing department requests.
6. Retrieve, collate, assemble, deliver, scan and file medical records in accordance with established policy.
7. Responsible for reporting of all release of information processing, per policy.

Experience

2-5 Years

Level

Executive

Education

Customer Service

Description :

1. Review insurance accounts to determine the action steps needed to expedite claims payment and/or monitor claims until paid or denied.
2. Perform necessary insurance follow-up actions to ensure prompt and accurate account resolution; assign accounts to the correct disposition based upon status.
3. Document conversations with responsible parties regarding accounts on both the company and client systems.
4. Utilize automated claims verification systems via phone or online systems.
5. Respond to incoming phone calls and email inquiries regarding patient/client accounts.
6. Professionally represent myself and the assigned client when interacting with the client, staff, patients, and guarantors.
7. Appropriately bill claims and post necessary insurance adjustments to accounts on client system.
8. Assist management staff in compiling and analyzing productivity data.

Experience

0-2 Years

Level

Entry Level

Education

Associate In Arts In Pre

Description :

1. Responsible for training employees about current managed care and insurance updates.
2. Assist Spanish speaking patients with appointments, billing questions and translate for medical personnel.
3. Audit electronic claims thru the EDI system.
4. Using the E-clinical works software posted daily insurance payments utilizing Electronic Remittance Advice and manually posting of checks.
5. Reconcile insurance payments to explanation of medical benefits.
6. Appealed denied or suspended medical claims.
7. Responsible for the audit of patient and insurance refunds using the excel spreadsheet.

Experience

7-10 Years

Level

Management

Education

Diploma

Description :

1. Greeted and prepared patients for dental examinations.
2. Coordinated appointment schedules for the dentist.
3. Reviewed status of waiting room on a routine basis to ensure that patients were being seen in a timely fashion.
4. Provided appropriate postoperative instructions as prescribed by dentist.
5. Thoroughly gathered and recorded medical and dental histories and vital signs of patients.
6. Expertly filed patients' charts and processed billing and payments.
7. Managed invoices and transaction receipts.
8. Accurately collected and recorded patient medical and dental histories.

Experience

2-5 Years

Level

Junior

Education

Associate Of Applied Science

Description :

1. Print and review invoices for accuracy according to company standards, department processes and insurance guidelines.
2. Enter appropriate and necessary information into the claims filing software in order to prepare required claims to be sent electronically.
3. Review customer accounts/patient accounts receivables/aging and take necessary steps to keep accounts current.
4. Contact insurance companies, obtain necessary documentation for insurance requests and request refunds and write offs as necessary.
5. Answerer incoming calls from patient sand clinicians about reimbursement, processes.
6. Maintain current files and billing records make changes as needed so patient information is accurate and complete.
7. Experience in, Medicare re-openings, re-determinations and appeals.

Experience

2-5 Years

Level

Junior

Education

Medical Billing Course

Description :

1. Reviewed and maintained the current status of all managed care and commercial insurance.
2. Re-billed claims with corrections and modifications to ensure reimbursement.
3. Obtained the necessary information to correct and process denied claims.
4. Noted all transactions and changes in patient demographic and patient notes for future claims.
5. Reviewed aging report daily to ensure all individual rejections were worked before timely filing issue arises.
6. Communicated coordination of benefits changes with other departments, as well as noting patient accounts.
7. Informed team lead or supervisor on any account problems and the resolution to solve problems.
8. Performed all duties in a professional and curious matter.

Experience

2-5 Years

Level

Executive

Education

Certificate In USA Army

Description :

1. Medical coding and insurance billing of charges.
2. Followed up on outstanding medical claims.
3. Went over daily reports to insure electronic claims had been sent and would troubleshoot any errors that have occurred.
4. Posted insurance remits to correct outstanding accounts.
5. Worked one on one with patients with financial shortcomings in order to come to a payment arrangement beneficial to both the patient and the practice.
6. Spoke with patients regarding questions about accounts and insurance related inquiries.
7. Managed schedule for six doctors and one nurse practitioner.
8. Worked closely with front office staff in order to keep schedule running smoothly.

Experience

2-5 Years

Level

Junior

Education

BS In Biology