Alicia Short
Dallas,TX
Summary
Seasoned Claims Adjuster with 13 years of experience, adept in medical claims and policy compliance. Proven track record in optimizing claims processes, ensuring accuracy and integrity in adjudication. Seeking Healthcare Claims Processor role to leverage expertise in provider relations and medical policy application. Experience across various states
Overview
14
14
years of professional experience
Work History
Workers' Compensation Claims Adjuster
Sedgwick
02.2015 - Current
- Conducted initial three-point contact claims investigations to determine compensability and ensure compliance with WC Statute and/or employers’ ERISA plan documents.
- Work in conjunction with the client and business partners keeping the informed as claims develop
- Maintain contact with the injured employee, medical provider, and employer to facilitate return to work
- Monitor ongoing medical reports and treatment plans to manage the claim and set reserves accordingly
- Review, approve, and manage medical treatment
- Support claim positions before legal proceedings by producing information, reports, and other documents as supportive evidence
Medical Claims Adjuster
Revive Community Health
02.2011 - 02.2015
- Analyzed policy details along with supporting documents provided by healthcare providers to make informed decisions on claims approvals or denials.
- Resolved complex claims issues for expedited processing and resolution.
- Collaborated with healthcare providers to obtain necessary documentation for claim support.
Education
Bachelor of Arts - Business Administration
University of Houston
Houston, TX06.2004
Skills
- Medical Terminology Proficiency
- Effective Communication Abilities
- Conflict Resolution Techniques
- Strong Analytical Skills
- Critical Decision-Making
- Insurance Claims Management
- Claim Validity Determination
- Organizational Skills
- Detail-oriented
- Written Communication
- Case coordination
- Claims management
- Policy interpretation
- Claims investigation
Timeline
Workers' Compensation Claims Adjuster
Sedgwick
02.2015 - Current
Medical Claims Adjuster
Revive Community Health
02.2011 - 02.2015
Bachelor of Arts - Business Administration
University of Houston
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