As an auditor I am to audit and look over every health insurance claim that comes in from our subscribers. We only work with health insurance claims from subscribers in Nebraska and that are federal employees. I am to figure out if they filled out the form correctly and fix any issues that are wrong with the health insurance claim. This can range anywhere from claims with Medicare as their primary insurance up to pricing issues which would require some coding to be done. This position also includes working with cpt, hcpcs and ICD codes. This is done through a computer.
- Claims Auditor at Blue cross blue Sheild Nebraska
- Associate Claims Administrator at Tyson Fresh Meats, Inc corporate
- Customer Service Representative at Longlines LLC
- credit application specialist at First Premier Bank
1 month at this Job
- - Human resource management
- 1 ½ yrs. in this position.
• Audited submitted client claims documents for sufficient data, verified that benefits were paid correctly and in accordance with appropriate plans and policies, and investigated claims liability to determine the extent of liability.
• Accurately processed claims according to policies and contracts, within the department time frames.
• Established expected "Financial Reserves" for continuing policy terms to cover upcoming Claim's Liability and adjusted them ongoing for duration of policy term, as needed. Underwent Six to Nine Months of extensive training on procedures.
• Data Entry and 10 Key Adding Machine, as well as, Excel Spreadsheet entries.
• Reviewed and interpreted Employer Plans of health coverage and excess insurance policy to Claims.
• Troubleshooting to resolve Third Party Administrator/Client claim processing issues.
• Authorize checks for amount of liability, disclosed to Client reasons excess policy amounts not covered.
• Referral of Checks and Reserves over $500K. to CEO, CFO, Company Attorney, and Compliance Management for special approval. Some Trigger Diagnosis referred to company Attorney, and Specialty Preliminary Claims - Nurse Case Mgmt.
• Developed work plans, establish timelines, and set goals for assigned workload. Performed work thoroughly in a cost-efficient manner, and at a high productivity level. 10 ½ yrs. in this position - Receptionist Administrative Assistant
• Answered Avaya Computerized Online Switchboard for over 250 Nation-wide employees.
• Facilitated Voice Over messages for the office holiday closings; utilizing the Avaya Telecommunications.
• Enforcing HIPPA regulations Screening & Greeting Clients with Surveillance Camera-Security Locks.
• Processing Specific Claims Auditor's, Accounting and Premium Departments with Special Check mailing.
• Responsible for following pertinent outgoing mailing instructions for Claims Reimbursement Checks.
• Special Mailing Letters for Premium, Commission, Refund Checks to TPA (Third Party Administrators).
- Specific Claims Auditor at Tokio Marine HCC Stop Loss Group
- Listing Coordinator at CB Richard Ellis
- Administrative Asst at Metro
12 years at this Job
- Bachelor's - Bachelor of Science Business Administration in Finance
- Associate - Science Accounting
As a high-dollar claims auditor, I extensively review submitted medical claims of significantly high dollar amounts to ensure charges are within federal and legal guidelines prior to approval for payout. I have acquired extensive working knowledge of medical terminology and ICD-10 coding, processing claims submitted on behalf of Tricare and Medicare beneficiaries both stateside and overseas. On a quarterly basis, I prepare requested claims and supporting documentation for audit and compose rebuttals for any applicable feedback. It is my daily duty to provide feedback to individuals regarding any assessed errors within quality and production standards, advising of common errors and best practices during established team huddles.
- Claims Auditor III (high-dollar) at WISCONSIN PHYSICIANS SERVICE
- Client Services Representative at Self Own Business
- Account Services Representative at Sprint Nextel/ NCO Financial Systems
- Sales Associate at Champs Sports/Foot Locker
1 year, 4 months at this Job
- Associate - Business Administration
- High School Diploma - Piano Performance
• Apply claim processing experience to audit and analyze all levels of claims processing procedures and workflows.
• Assigned to handle second level review for high dollar claims prior to release of payment.
• Independently run reports on errors identified for potential error trends and report the results to Claims management and Claims Trainer.
• Handle complex and urgent special projects from external provider and internal departments.
• Assist the PDR department with high profile projects.
• Assist Claims Trainer with analyzing Claim error trends.
• Serves as the primary back up for the Trainer in regards to Claims Change Form requests from the Contracting department.
• Analyze and prepare Health plan claims selections for Annual health plan audit. Review samples provider by clerical staff and ensure claims payments are accurate and all documentations required by the health plan auditor are present at the time of audit.
• Assist the Recovery Specialist in corresponding with external providers regarding Claims Overpayment requests.
- Senior Claims Auditor at Alignment Healthcare
- Senior Transplant Auditor at AIG - South Coast Metro-CM/SA
- Senior Claims Auditor at Memorial Health Care Foundation
- Accounts Receivable Representative at Orange Coast Oncology-Hematology
2 years, 6 months at this Job
- Some college
Temp position at Providence Health Services, Beaverton, OR. Auditing claims payment and billing codes. Using Microsoft Access, Excel, and Salesforce CRM. Identifying and replacing expired medical billing codes. Processing synthetic claims to ensure claims were being priced correctly. Verifying contracts between providers and medical insurer and setting up claims system to process claims correctly.
- Claims Auditor at Robert Half
- Short Term Disability Benefits Examiner at The Standard Insurance
- Senior Operations Production Coordinator for Billing Disputes at Capital One
- Claims Analyst, Customer Service Representative at Adecco
6 months at this Job
- A.A.S - Accounting
- Accounting Clerk Certificate - Accounting
- Certificate - Medical Office Clerk
Customer service,process claims in a timely manner, work on dual computers.
- Claims Auditor at CIGNA HEALTHCARE INC
- Server at Olive Garden
- Server at Cracker Barrel
- Dunkin Donuts Crew Member at Dunkin' Donuts
1 year, 11 months at this Job
- Associate - Marketing
Duties: High volume Inbound/Outbound calls from and to customers. Investigating/paying claims, verifying customer information detail by detail.
- Claims Auditor at Alorica
- Associate of Occupational Science in Medical Assisting w/Clinical Concentration at Centura College
- Secretary at Saun Publishing Company
- Cashier/Customer Service at Sheetz Incorporated
6 months at this Job
- - Childhood Education
Submit claims and claim corrections for Medicaid, Medicare and Private Insurance Interprets detailed paid claims reports, eligibility reports and payment reports to determine if additional payment or a refund is required
- Claims Auditor at NetCare Access
- Medicad Advocate at Aetna Insurance Company
- Telephone Banker at J P Morgan Chase
- Customer Service Representative at Funai Service Corp
6 months at this Job
- High School Diploma
-Responsible for processing all professional claims for Medicare members - Performed all authorized duties in the processing of claims allocated to the assigned market consistent with all applicable company and departmental policies. - I have the ability to understand and implement appropriate claims processes and courses of action when adjudicating claims - Demonstrate strong analytical problem solving skills. Advanced understanding of medical terminology, claims coding - Exceeded quality standards for Financial Accuracy Rate (FAR), Statistical Data Accuracy (SDA), and Overall Accuracy Rate (OAR).
- Claims Auditor at Careplus
- PERM Auditor at Chickasaw Nation Industries
- Claims Auditor at Jacobson Group
- Claims Auditor at Dell Corporation
3 years, 5 months at this Job
- Some college
Audit medical and dental claims and discuss findings with claims examiner to confirm errors and procedures. Review transactions, documents, records, reports and methods for accuracy and effectiveness. Request and processes received refunds from providers and make appropriate adjustments in computer system. Maintain and update audit reports. Compose refund correspondence to providers for the request of overpayments. Apply refunds to corresponding claims and process refunds in the system. Handle subrogation and recovery of medical claims eligible for reimbursement recovery from third party carriers or law firms. Maintain and update subrogation reports. Discuss subrogation findings with claims examiner. Make recommendations for the correct and/or improvement of internal, operational and management control systems and organization unit performance.
- Claims Auditor at The Lewer Agency
- Customer Service Coordinator at The Lewer Agency
- Collections Lead at MCCS/Macy's Credit and Customer Service
- Account Executive at KEZK Radio
10 months at this Job
- Master - Business Organization