PROFILE
Senior Medical Claims Examiner with experience from third party administration, re-insurance and government programs to fully insured plans. Medical Terminology, contract interpretation, customer service.
Also experienced in procurement support, human resources, budgeting, data administration, and business administration support.

APPLICATIONS
FrontPage, Access, Excel, Visio, Power Point, MS Project, various proprietary IBM Insurance programs, some basic HTML.

EXPERIENCE
MEDICAL CLAIMS
I received my training at Blue Cross of Southern California, from hospital to professional claims on Union contracts like Carpenters Health and Welfare, Cement Masons and others.
I went from customer service and phones to Research and Adjustments in 6 months. I processed everything from basic hospital benefits, to professional claims, to prescription drugs, COB and Medicare. At the time we had both basic and major medical benefits. Always handled the most difficult cases.

Multi Hospital Shared Services
I administered self funded medical plans of major Hospitals in the Southern California area.
We were a staff of four claims examiners processing everything from A-Z . I was also involved in interviewing and training new employees.
We started out doing manual claims and went computerized after about 2 years. We handled our own phones and customer inquiries.

Home Life Arcadia, CA
I processed everything from medical to dental to disability claims.
I handled cases such as Mini Mart, Inyo County and Bloom Advertising agency.
Usually assigned to the most difficult customers/cases and able to turn unhappy customers into happy ones.

US BENEFITS/Harbor Insurance
Medical re-insurance benefits.
I worked claims greater than $10,000.- /year with 12/12, 12/15 and 12/open contracts. incurred/paid in 12/ etc...
coordinated and requested information from hr personnel and providers as well as insurance carriers.
determine if claims would qualify for the reinsurance coverage and its terms.

ESCOBAR ADMINISTRATORS Los Angeles, CA
Reinsurance Co-ordinator
Submitted re-insurance claims to various re-insurance carriers for third-party administrator.
Evaluated claims to ensure they qualified for re-insurance benefits.
Implemented tracking system to reduce turn around time and follow up where needed.
Reduced turn around time 70 %, by training examiners in completion of pack a ges to get proper reimbursement by re-insurance carriers. Turn around time improved due to complete information provided in a timely manner.


GROUP HEALTH Seattle, WA
Administrative Assistant
Assisted Project Director with conversion of new Patient Accounting System.
Supported 25-member project team by coordinating programmer and trainer schedules, preparing training materials, tracking clinic devices, invoicing and providing miscellaneous assistance.


INSURANCE OVERLOAD SYSTEMS
Senior Claims Processor, King County Medical (Basic Health), Blue Cross of Washington, and PacificCare
h Processed medical claims for several Washington healthcare programs