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Click here or scroll down to respond to this candidateCandidate's Name
Street Address View WayLakeland, FL Street Address
PHONE NUMBER AVAILABLE CellSummary of Qualifications:Personal Injury Protection, Bodily Injury, and Uninsured Adjuster, experience with negotiations and settlementsWorkers compensation medical bill review and follow upMedical Unit Secretary, Medical Coder and Administrative AssistantExperience also includes auditing medical bills for Insurance companies and experience with the Clerk of Courts legal systems.Professional01/2007 - Present Anthem Blue Cross and Blue Shield, Tampa FLClaims Analyst III (Health and Dental)Responsible for processing all advanced level claims transactions.Accurately interprets, understand and apply Medicaid contracted rules.Understand and implement appropriate claims processing and course of actions with adjusting claims.Responsible for preparing correspondence, maintenance of phone logs & provider contact logs, as well as projects resolution of all AmeriGroup marketsCode and review medical bills, strong knowledge of medical terminology, Coding and hospital per diems Code HCFA 1500, apply Fee Schedules.6 months experience working on the adjustment team.Trained to work CWS station (Pega 7)Trained to work the new FUSE system (Pega 8)05/2006 - 01/2007 First Acceptance Insurance, Tampa FLComplex Liability AdjusterInvestigate, evaluate and equitably settle various claims exposures of a complex nature. Conduct a complete and factual investigation to determine coverage, liability and damages. Negotiate bodily injury settlements with both unrepresented claimants and attorneys. Negotiate total losses. Research statues for legal issues and give guidance to other employees on those issues as well as contractual issues.03/2004 - 05/2006 Clerk of Courts, Bartow, FLSupport Specialist D/Hearing SpecialistProcessing Citation TicketsBuilding Defendant HistoryBuilding Non -Arrest CasesProcessing Notices/Juvenile CasesSummonsDUI Immobilization Procedure before court hearingTransfers to and from Circuit Criminal10/1997 - 03/2004 GEICO Direct Insurance, Lakeland, FLAdministrative Assistance/Medical CoderAudit and process medical bills from auto accidentsUpdate and process new CPT code to the databaseProcess settlement checks for Attorneys and ClaimantsLog all ADR mediations and structure settlementsPrepare vouchers for associates reimbursement and update claims businessNotarize all Affidavits of Coverage for adjusters on a daily basisReconcile error and other Home office reportsProcess five months outstanding checks and IRS reportsLicensesFlorida State 520 licensesEducationRoffler technical Institute - Received Certificate Department of Education, State of Florida Nursing Certificate |
