• Utilize professional customer service skills when contacting insurance companies regarding claim status.
• Follow up on government and or commercial hospital claims to recover reimbursement from insurance.
• Determine claim status by checking EOB’s and or remits by direct provider contact or online portal.
• Determine if claims can be rebilled with other qualifying ICD 10 or CPT codes.
• Investigate reasons for denials such as COB, missing modifiers, provider credentialing, duplicate claims, and reprocess for payment.
• Determine if adjustments are necessary due to provider error, such as missing pre-auth, non-covered charges, or past timely filing within Medicare, Medicaid, or commercial insurance guidelines.
• Follow HIPPA and Privacy guidelines to ensure proper handling of patient private information.
- Health Insurance Claims Representative at Professional Service Bureau Health Insurance Claims Representative
- Mnsure Health Insurance Representative 1 at State of Minnesota
- Customer Service Reimbursement at McKesson (Medimart)
- Sales Retention/ "Save The Sale" at Select Comfort Corp
1 year, 11 months at this Job
- Diploma of Medical - Medical
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
Currently working as a Claims Representative for Hagerty Insurance. Daily task are filing claims, uploading estimates and photos, contacting appraisal companies, setting up VIX Bids, taking phone calls, and working hand and hand with adjusters.
- Claims Representative at Hagerty
- Photographer at Freelance/Self employed
- Nursing Assistant at Munson Healthcare
- Assistant Property Manager at Northport Point Service Company
5 months at this Job
- High school
Medical Only Claims Representative Duties: Sets up and manages medical only files in accordance with corporate claim standards and Michigan Worker's Compensation law, requests and monitors medical treatment of designated claims in accordance with corporate claim standards, summarizes all correspondence and medical records in claim log notes, closes claim files when appropriate, and communicates timely with clients, claimants, and medical providers.
- Claims Representative at CCMSI
- Teacher/Caregiver at Kids Campus
- Sales Associate/Cashier at Ferris State University Pro Shop
- Summer HIM Intern at Henry Ford Health System
4 months at this Job
- Bachelor of Science in Health Information Management - Health Information Management
Responsible for investigating property claims via phone, electronic documentation of claim information, and customer service Field Claims * Advanced to investigating property loss claims at loss location assessing for damages and preparing estimates * Determined coverage, liability and identified subrogation potential National Catastrophe Team Claims * Assigned to residential property damage assessment during catastrophes nationwide. (Chicago, Indianapolis, Detroit) * Supervised independent adjusters by field riding, reviewing files and making constructive suggestion on file management Mid Loss Claims * Promoted to Residential Fire Loss investigation on losses ranging from $30,000 - $75,000. * Assessed properties for damages, prepared estimates for repair/replacement and issued compensation checks. * Negotiated with multiple contractors for repairs Commercial Property Claims * Investigated commercial losses via phone, completed electronic documentation of claim information * Completed estimates with Xactimate estimating system based on information provided from insured Commercial Property Team Leader * Supervised Commercial Field Claims Representatives, provided training of new employees * Conducted case reviews and evaluated Claims Representative performance by continuous review of claims statistics, open and closed file evaluations, re-inspection, and observation of activities in the field * Reviewed the settlement activity of the Field Claims Representatives.
- Claims Representative at Farmers Insurance Group
- Social Service Supervisor at
- Screening Officer at Jackson County Juvenile Court
- Social Service Worker at
21 years at this Job
- B.S. - Sociology
GENERALI GLOBAL ASSISTANCE - San Diego, CA
Insurance and emergency assistance services for trip cancellation, trip delays, trip interruptions, baggage delays, lost luggage, vacation rentals, property damage and medical emergencies.
Claims Representative (2017 - Present)
• Investigated each claim by contacting the appropriate parties, documenting statements and utilizing resources.
• Conducted investigations of claims of moderate to complex claims, confirmed or denied coverage in accordance to insurance policy contracts.
• Request, review and communicated medical information while compliant with HIPAA.
• Provide quality claim handling throughout the claim life cycle, while following Department of Insurance regulations and guidelines.
• Continually obtained above average performance reviews.
- Claims Representative at Generali Global Assistance
- Insurance Appraiser III / Product Specialist Internship at MITCHELL INTERNATIONAL
- Sales Agent / Live Chat Agent / Customer Service Representative at
- Team Leader / Mechanic / Customer Service Advisor at JIFFY LUBE
2 years at this Job
- High School Diploma
Responsible for sending referrals to specialists, follow-up, insurance verification and approvals. Responsible for sending medical records and correspondence to complete the referrals. Claims Representative, Claims and insurance denials for Imaging, ER charges, labs, and etc.
- Referral Coordinator/Claims Representative at Robert Half Staffing
- Scheduling Rep at THR Fort Worth
- Provider Concierge at Aerotek Staffing Service (NTSP)
- Clerical Representative at Professional Medical Services
4 months at this Job
Worked for CVS Pharnacy account on a nationwide level. . Responsible for handling of bodily injury, property damage, products and discrimination claims for the client. Extensive communication via telephone and written correspondence with corporate client, claimants, legal entities and in house management. charged with investigation, evaluation and hegotiation of store related insurance liability claims.
- Claims Representative at Sedgwick Claims Services
- Claims Representative at
1 year, 1 month at this Job
- Bachelor's - Theater Arts
- Two years of Claims Representative experience as a bilingual representative - Continuously exceeded in five out of six metrics; to include quality, customer experience, capturing and retaining GEICO'S auto repair express program, self-performance reports, and customer service surveys - Recognized as Employee of the Month for the months of March 2017 and February 2018 - Demonstrated excellent customer service by receiving compliment calls from policyholders 5 separate times - Provided efficient claim handling with a perfect score for my year to date in self-performance reports - Continuously demonstrated teamwork by assisting coworkers in completing overdue entries in between calls; completed over 80% of overdue entries - Multi-Tasked on a daily basis by assisting customers in translating and documenting conversation - Assisted team members in translating recorded interviews in a word document for use in arbitration Supervisor/Manager
- Claims Representative at GEICO
- at 927th Military Police Mission Support Group/US Air Force
- Campaign Manager at 927th Military Police Mission Support Group/US Air Force
- Assistant Manager at Finish Line
2 years, 10 months at this Job
- Bachelor of Science - Business Administration
- Certification - Professional Bookkeeping
- High School Diploma
Description: Receive and determine disposition of new auto damage claims for Hertz, Dollar, and Thrifty. Act as liason between renters and insurance companies. Obtaining all documentation, preparing, and sending subrogation's. Monitoring and assessing claims to ensure prompt resolution. Negotiating settlements, recovering damages, and setting up payment plans. Processing disputes and determining if they are valid or invalid.
- Claims representative at The Claims Center
- Collections Agent at Makotek
- Tier I Tech Support at
- Surveyor, Supervisor at
7 months at this Job
- Associates of Art - Art