Claims representative, assisting providers in detailed information about claims that were submitted to Molina Healthcare, on behalf of the members. Knowledgeable of the ICD 10, adjustments and claims in review. Databases used to assist consist of reading claims submissions, grievances filed, as well as miscoded claims. Advised providers of status updates, billing information, paid out status as well as evidence of coverage. Also assisted with Member Services, which includes speaking to members, providing eligibility and provider information. Processing of changes of providers or updating member's personal information. Used state databases to determine eligibility, also working with the pharmacy, utilization as well as enrollments department to answer inquiries and researching of benefits. Other duties as a Member Services representative included updating and sending out Protected Health Information verifications, as well as processing return mail and reviewing past due call trackings on downtime.
- CLAIMS REPRESENTATIVE at MEMBER SERVICES REPRESENTATIVE MOLINA HEALTHCARE
- RECEPTIONIST/HOSTESS SAN PEDRO FISH MARKET & RESTAURANT at
- CUSTOMER SERVICE at FRONT OFFICE ALPINE VILLAGE
1 year, 5 months at this Job
- HIGH SCHOOL DIPLOMA
- - Science, and Modern History
• Handled Bodily Injury, Product Liability, and Property Damage claims nationwide for Fortune 50 company The Home Depot
• Was promoted from Claims Associate to Claims Representative after 16 months
• Earned monthly top performer award 10 times out of 26 months.
• Licensed Claims Adjuster in 40 states including all of the Southern states.
• Worked with the Juris risk management software to adjust claims made against The Home Depot
- Claims Representative at SEDGWICK CLAIMS MANAGEMENT SERVICES
- English Teacher at INTERNATIONAL LANGUAGE ACADAMY
- Leasing Consultant at SYCAMORE PROPERTY MANAGEMENT
3 years, 2 months at this Job
- B.S. - Interdisciplinary Studies
Claims Representative Inbound call center taking first notice of loss for home/auto claims. Taking reports of details, paying close attention to detail, reviewing, setting up inspections for adjusters, meet productivity and AHT, adherence.
- Claims Representative at Auto Club Group
- Retention Representative at Charter Communications
- Customer Care Representative at Anthem Inc
- Customer Care Associate at XEROX
9 months at this Job
- Associates in Business - Business
SIU - Multi Claims Investigative Unit Claims Representative
Special Investigative Unit Claims Representative
Fire Casualty Claims Representative
Bodily Injury Auto Claims Representative
• Within almost five years at State Farms Insurance I was promoted to higher positions due to continuous exceptional work product and skills.
• Experience in both homeowners and auto casualty claims.
• Investigated suspicious claims with NICB indicators from start to finish, including coverage denials, investigation of ring activity and medical fraud.
• Attended depositions and Examinations Under Oath, analyzing the claim and legal applications.
• Worked with counsel on legal strategies for defense, declaratory relief actions, and affirmative litigation.
• Canvassed areas for surveillance and witnesses.
• Conducted traffic investigations by obtaining photos, measurements, and questionings nearby businesses and witnesses.
• Attended small claim court hearings assisting insured in their defense of non-meritorious third-party claims.
• Obtained recorded statements over the phone or in-person from all interested parties.
- CLAIMS REPRESENTATIVE at STATE FARM
- CLAIMS COORDINATOR at MEGA APPRAISERS
- CLAIMS ADJUSTER at AUTOMOBILE CLUB OF SOUTHERN CALIFORNIA
- VICE-PRESIDENT'S ASSISTANT at WOODBURY UNIVERSITY
4 years, 9 months at this Job
- BACHELOR OF SCIENCE - Graphic Design
As a claims representative, I am responsible for processing phone insurance claims for Verizon wireless customers. Customer service as well as having empathy is where I shine with this position.
- Claims Representative at Iqor asurion
- Patient Care Coordinator at Alliance RX Walgreen's Prime Specialty Pharmacy
- Contact Center Representative at RealPage, INC
- Collector at Southwest Credit Systems
1 month at this Job
- High School Diploma
I answered phones calls and did insurance claims for auto, property and glass claims.
- Claims Representative at Strategic Claims
- Server at Texas Roadhouse
- Self Employed Horse Trainer at
4 months at this Job
- None - Equine Science
- Some college - Equine Science
- High school or equivalent - Graduated in 2013
Customer service,help clients with claims,data entry
- Claims representative at US Claims
- Customer Care Agent at Conduent, Inc
- Tax Preparer at Liberty Tax
- Sales Representative at Target Mobile
2 months at this Job
● Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
● Processes claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
● Communicates claim action/processing with claimant, client and appropriate contact.
● Ensures claim files are properly documented and claims coding is correct.
● Maintains professional client relationships.
- Claims Representative at Sedgwick Claims
- Home Team Lead at West at Home Corporation
- HR Manager at Goodyear Manufacturing Plant
- HR/Professional Development Coordinator at Spalding Regional Medical Center
2 years at this Job
- Bachelor's of Business Administration in Management - Business Administration
Claims Representative duties as follows, determining covered declare value of packages by studying provisions of policy or certificates. Establishing proof of loss by analyzing claims documentation To make sure customer invoices are correct and filled out correctly; inquiring about additional information as needed from shipper if necessary, initiating or conducting investigation of questionable claims. Documenting claims actions by completing forms, reports, logs, and records. Resolves package claims by approving or denying documentation; calculating benefit due; initiating payment or composing void letters. Ensures legal documents from the following company policies, procedures, guidelines, coherent to the correct paper work. Maintaining good quality customer services by following customer service practices and responding to customer inquiries. Protects operations by keeping claims information confidential at all times. Prepares reports by collecting, analyzing, and summarizing all information. Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
- Claims Representative at Alorica
- Sales Associate at Stein Mart
- Toddler Teacher at Childtime Learning Centers
- After School Program Aide at Healthy Families
8 months at this Job
- Associate - Cosmetology
- - High school diploma
As a claims representative, my responsibilities were to submit claims using Medicare/Medicaid in a fast paced environment. It was necessary to problem solve both on my own and with the help of my supervisor if needed.
- CLAIMS REPRESENTATIVE at UCONN HEALTH CENTER
- BAKERY CLERK at HIGHLAND PARK MARKET
1 year at this Job
- - Marketing