Senior Claims Analyst III Resumes in US-Georgia-Savannah: Gretta

Senior Claims Analyst III Resume

Contact Candidate

Name:

Gretta

Location:

US-Georgia-Savannah

Experience:

Willing to Relocate:

Willing to Travel:

Most Recent Job Title:

Senior Claims Analyst III

Personal Website:

Objective:

My objective is to obtain a stimulating and rewarding position in an established medical practice or insurance firm.

Resume Text:

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ement, organization and dedication
· Excellent oral, written and interpersonal skills
· Experience with Access, Excel, Goldmine, Lotus, Peachtree Accounting, PowerPoint, QuickBooks, Word

WORK EXPERIENCE
Claims Analyst/Processor of Medical Claims, CBCA Inc., Savannah, Georgia
April 2004 thru Current
· Verifies Coverage and Benefits for Providers and Claimants
· Performs Status Checks on claims for Providers and Claimants
· Performs data entry skills as well as general clerical skills as required
· Reviews and processes medical health claims for TPA of Self Insured Groups, which includes verification of coverage, COB, and adjudication of claims per policy guidelines and contracted allowances

Front Desk Clerk/Scheduler, Provident OB/GYN, Savannah, Georgia
October 2003 thru April 2004
· Scheduled appointments, checked in patients, verified coverage, scheduled diagnostic tests at facility outpatient departments and collected co-pays, co-insurance and insurance information from patients, obtained pre-certification and referral authorizations for patients

Claims Analyst/Client Services Rep, Evergreen Re, Inc., Stuart, Florida
November 1999 thru June 2003
· Installed claims systems for clients nationwide related to health re-insurance, professional, facility and global claims, including transplants and risk analysis
· Reviewed and prepared commercial, Medicare and Medicaid reinsurance claims
· Adjudicated claims and reviewed Bordereaus and EOB’s after processing by reinsurance carrier, reviewed for contracted rates, appealed claims as needed
· Instrumental in designing and maintaining database on Accounts Receivable log for any outstanding claims
· Worked extensively with electronic downloads from Excel and Access formats as well as ‘manual’ submissions related to claims filing, analysis of data, and RFP preparation including Trending
· Traveled nationally to meet with clients; prepared Agenda’s for those meetings

Licensed Property Manager, Condo Connection, Inc., Pt St Lucie, FL
April 1994 thru December 2001
· Provided Property Management and Accounting for Homeowner and Condominium Associations
· Licensed in the State of Florida as Community Association Manager.

Front Desk Clerk for Multi-Specialty Clinic, Mid-County Medical Center,
West Palm Beach, Florida - January 1980 thru December 1983
· Scheduled appointments, checked in patients, verified coverage, scheduled diagnostic tests at facility outpatient departments and collected co-pays, co-insurance and insurance information from patients

EDUCATION
Financial Accounting I - Indian River Community College, Fort Pierce, FL - 1999

Community Association Manager - University of South Florida, Miami, FL and Gold Coast School of Real Estate, Ft Lauderdale, FL - 1995

Business Math, Business English and Medical Terminology I & II - Draughon’s Junior College, Lake Worth, FL 1983 - 1984

Certification in Nursing Assistant and Licensed Practical Nursing - West Tech Education Center, Belle Glade, FL 1982 - 1983

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