Annette Crews
White Bear Lake,MN
Summary
Claims Examiner with extensive knowledge and experience in processing medical claims. Solid abilities in developing objectives and strategies to resolve both routine and complex medical claim issues. Excellent skills compiling, coding, categorizing and auditing information to process claims.
Overview
25
25
years of professional experience
Work History
Senior Claims Examiner
Health Partners, Inc.
01.2000 - Current
- Examines and processes complex medical claims professionally, while maintaining confidentiality and achieving satisfactory resolutions.
- Analyzes Plan and provider coverage details meticulously, ensuring accurate determination of benefits payable for each claim.
- Adjudicates claims for payment, denial, or disallow in accordance with Plan and provider coverage provisions, policies and procedures.
- Completes complex adjustments to previously processed claims to correct payment detail or online information.
- Performs system overrides to manually calculate the benefit amount for claims based on Plan and provider arrangements when the system is unable to automate the calculation.
- Maintains up-to-date knowledge of industry trends and legislative changes, ensuring accurate claim evaluations.
- Develops and maintains effective relationships with key stakeholders, fostering a cooperative working environment.
- Actively participates in team committees to improve claims processing, enhance production quality, and development of on-line documentation.
Education
No Degree - Communications Media
Southwest State University
Marshall, MNSkills
- Claims analysis
- Coverage interpretation
- Analytical problem-solving
- Diagnostic coding
Timeline
Senior Claims Examiner
Health Partners, Inc.
01.2000 - Current
No Degree - Communications Media
Southwest State University