Claims Adjuster/SME Resume Tampa, FL - Hire IT People

PROFESSIONAL SUMMARY:

Driven and compassionate healthcare professional with more than 10 years’ experience adjudicating claims in Facets.
Motivated and enthusiastic leader, fostering student learning and adult inspiring others to grow and achieve their goals.
Exceptional analysis and research skills, therefore, focus on getting the job done right the Confidential time.
Understands the importance and economic impact of paying providers on time and as per contract.

SKILL HIGHLIGHTS:

PROFESSIONAL EXPERIENCE:

Confidential, Tampa, FL

Claims Adjuster/SME

Responsibilities:

Adjudicates over 2000 professional and facility claims on a weekly basis.
Resolved provider appeals and email inquiries in a timely manner.
Process refunds and overpayments on a project basis, as needed.
Audits team’s work to ensure quality and accuracy.
Communicates with Lead and senior analyst of a designated client, to ensure speedy resolution.
Assist with new hires.

Confidential

Teacher

Responsibilities:

Designed and executed age/ grade appropriate lesson plans.
Established and communicated clear objectives to staff, parents and students.
Created a library and implemented new techniques to encourage student reading and language development and foster community within the classroom.
Supervised field trips to local businesses, the park, city gym for sporting events and the museum.

Confidential, Tampa, FL

Claims Adjuster

Responsibilities:

Adjudicated medical claims.
Provided accurate and appropriate information in response to provider inquiries.

Confidential, Coral Springs, FL

Team Lead Trainer

Responsibilities:

Trained new hires and cross- trained seasoned employees on new processes
Handled difficult clients and escalated issues.
Assisted with the development of the call center's operations, quality and processes.
Helped and development staff with all aspects of .
Offered specific programs to help employees improve and maintain job skills
Interview and evaluated prospective hire.