More than 10 years experience working in the health insurance industry. Proficient in understanding andworking with ICD9 diagnostic codes and CPT terminology. Computer experience working with MicrosoftWord, Excel, Microsoft Office, Company specific software. Excellent customer service, phone, email andletters sent by mail. Accounting experience Very dependable and hard working. Excellent organization,time management and data entry skills. Flexible in learning new skills

· Audit medical, dental, life and disability claims for payment and procedural accuracy for development of future trend and analysis. · Produced month end reports for high and low dollar claims using Excel spread sheets. · Authority for approving claims up to the 30,000 level. · Handle Claims Analyst and Examiner error disputes.

· Analyzed and processed claims for group and individual policies up to the 10,000 level. · Coordinated benefits with other insurance companies, Medicare and Medicaid. · Paid claims in an accurate and timely manner. · Worked with PPO and HMO networks (PPOM, Healthlink, PHCS, ect) to obtain claim pricing and corrected discount amounts. · Ability to Manually price claims through vendor websites (Multiplan- PHCS, First Health networks, ect.).

· Reviewed insurance claim appeals from providers and insureds · Made necessary claim adjustments and refunds when necessary. · Process high dollar claims billed by hospitals and doctors on UB04 and HCFA 1500 forms · Total customer service including calling patients, typing letters and coordinating benefits with other insurance companies, Medicare and Medicaid.