Roald Smith Email & Phone Number

Carmel, Indiana

Processed and authorized payment of individual health insurance claims up to the authorization limit, specifically claims arising from heart disease, heart attack or stroke, including, but not limited to, the following:• Interpreted the provisions of various types of health insurance policies to determine whether benefits may be paid on claims as submitted.• Initiated investigations on contestable or unusually large claims to determine the validity of all expenses submitted for reimbursement.• Demonstrated working knowledge of Microsoft Word, Excel and Outlook as applicable in the claims area.

Indianapolis, Indiana Area

 Recovered in excess of $50,000 in subrogation liens for self-funded group plans in 2001. Recognized, documented and pursued active pending subrogation cases for lien amount recovery totaling in excess of $200,000 in 2001-2003. Developed and implemented Microsoft Excel spreadsheet in order to provide easy-to-use listing of active subrogation cases for reporting to management and as an aid in answering telephone inquiries. Updated and greatly expanded previous company memo on subrogation procedures into comprehensive procedures training manual, much of which was incorporated into claim procedures and policies manual.

Indianapolis, Indiana Area

Processed medical and dental claims for self-funded group employee health plans, with 95% accuracy or higher on WLT MediClaims and ChekClaims systems. Received awards at least twice in the last 6 months for 100% accuracy. Released claims and generated auto adjudication reports on the WLT ChekClaims auto adjudication system. Trained another claims examiner to generate WLT auto adjudication reports. Utilized Microsoft Word in producing letters and forms for correspondence with clients and medical providers. Completed and disseminated claim inventory reports on management request..Was able to assist the Company regarding a major client's employee, who was traveling with his wife in Germany when she suddenly became very ill and had to be taken to a hospital there by ambulance. I was able to translate all of her medical bills into English and convert the charges from Deutschmarks (this was before the Euro) into dollars, so that our client could forward the correct payment to their employee to pay his wife's bills.

Bachelor Of Arts (B.A.), German Studies

Activities and Societies: Alpha Phi Omega Service FraternityParticipated in service projects benefitting the college community.

Master Of Arts (M.A.), German Studies

Activities and Societies: I was a graduate student and teaching assistant in German at SIU and took part in the activities of the German.

Diploma, Pre-College

Activities and Societies: Band