Judith N. Email & Phone Number

Orange County, California, United States

▪ Performs Supervisor’s task when a Supervisor is absent▪ Assists Trainer for review; updated/modified Crossover Desktop processing guidelines▪ Monitor and delegates aged claims to staff via email to bring down the inventory to meet Turn-Around-Time (TAT 95% and above)▪ Collaborates with IS team to prevent system error in claims processing▪ Reviews triage and processes Letter of Agreement (LOA), reviews transplant multi-million dollar claims▪ Handled government cases: Triage case, concluded summaries, and provided all supporting documentations to Legal Department in a timely manner▪ Conducted training and audit claims: 2 past trainers, 4 former Supervisors, 2 temps and other new teams for Crossover claim processing▪ Accomplished creating questionnaire/answer responses on Excel spreadsheetSr. Claims Examiner, 2009-2014▪ Processed medical, hospital and Medicare crossover claims

Santa Ana, California, United States

• Processed Officeally and Image claims, manually input information into Eldorado system. (80+)• Validated providers PPO plan using First health and PHCS program.• Analyzed claims for possible duplicates, pre-existing conditions, member's coverage and termination dates and other secondary insurance. Sent letters to members for accidental details and pre-existing information.

Irvine, California, United States

• Processed Edi (Electronic) CMS 1500 form claims; Data entry paper claims into HPCS -UNIX system.(80+ claims) manually / (Medi-Cal, Medicare EOB, Dental and Vision Plans).

Irvine, California, United States

• Reviewed, analyzed, solved and processed CMS 1500 form claims into EZCap system in a timely manner. (150+ claims) (Medi-Cal and Medi-Care).• Utilized PSD form (Provider Service Data) to update provider's correct information into database and benefit tables appropriate to the member's health plan.• Investigated reject files identified corrected any issued claims that can be processed in timely manners.• Verified claims for correct IPA database and distributed to proper claim examiners. (Medi-Care, Medi-Cal / Healthy Families/Healthy Kids, Commercial & POS).