Arthur Jones
Providence,RI
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
16
16
years of professional experience
Work History
Complex Claims Adjustment Processor 2
Point32Health
04.2016 - Current
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Managed workload and priorities to meet claims processing meet deadlines.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Generated, posted and attached information to claim files.
- Monitored and updated claims status in claims processing system
- Evaluated medical claims for accuracy and completeness and researched missing data
Complex Claims Adjuster Level 1
Tufts Health Plan
04.2011 - 04.2016
- Examined claims forms and other records to determine insurance coverage.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Researched and analyzed policy contracts to verify proper payment of claims.
Core Health Insurance Claims Adjuster
Tufts Health Plan
04.2007 - 04.2011
- Documented all investigation activity and presented reports to management.
- Examined claims forms and other records to determine insurance coverage.
- Answered customer questions regarding deductibles.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Education
High School Diploma -
West Roxbury Academy
West Roxbury, MA06.1990
Skills
- Research and Analysis
- Administrative Procedures
- Database Maintenance
- Work Organizing and Prioritizing
- Claims Knowledge
- Recordkeeping Organization
- Claim Validity Determination
- Productivity Standards
- Claims Auditing
- Analyzing Claims
- Claims Procedures
Timeline
Complex Claims Adjustment Processor 2
Point32Health
04.2016 - Current
Complex Claims Adjuster Level 1
Tufts Health Plan
04.2011 - 04.2016
Core Health Insurance Claims Adjuster
Tufts Health Plan
04.2007 - 04.2011
High School Diploma -
West Roxbury Academy