Bethlehem Geremew
Moreno valley,CA
Summary
Diligent Claims Examiner with solid background in processing and evaluating insurance claims. Effectively managed numerous cases, ensuring accurate and timely resolution. Demonstrated strong analytical skills and attention to detail in complex claim assessments.
Overview
2026
2026
years of professional experience
Work History
Claims Examiner
Promise Care Medical Group
2024 - Current
- Evaluated claims for accuracy and completeness, ensuring compliance with industry regulations.
- Processed high-volume claims efficiently, maintaining quality standards and minimizing processing time.
- Collaborated with healthcare providers to resolve discrepancies and clarify claim details.
- Trained junior examiners on best practices for claims processing and customer service excellence.
Medical billing
ETS Express Trans System
01.2019 - 2025
- Bill Medical transportation to an insurance company for reimbursement. Review claims to make sure the billing amount and all info is correct before billing. Add the patient into Office Ally if the patient is new. Check authorizations to make sure service was authorized before billing.
Claims examiner II
Nautilus (Greater Newport Physicians)
11.2008 - 01.2012
- Resolve medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letters. Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations. Protects operations by keeping claims information confidential. Documents medical claims actions by completing forms, reports, logs, and records. Pay and process claims within designated authority levels. Maintains quality customer services by following customer service practices; responding to customer inquiries. verify insurance claims and related documentation. follow insurance procedures and submit claims correctly. Responsible for examining UB92 and CMS-1500 claims. Responsible for processing over 150 claims daily. Help managers with different projects.
Claims Examiner
Western Medical Management
01.2004 - 01.2008
- Process Cal-Optima as well as commercial claims Help provider dispute and customer service department with different issues. Confirm that the cost of the procedures accurately reflects the given diagnosis and verify claims to see whether certain treatments, tests or procedures are reasonable based on a patient's condition. Enter claim payments, reserves and new claims on the computer system, inputting concise yet sufficient file documentation. Resolve complex, severe exposure claims, using high service oriented file handling. Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
Claims examiner
Prospect Medical Management
12.1998 - 01.2004
- Paying hospital and professional commercial/ senior claims. Help out customer service with claims questions. Auditing claims adjustment and assisting managers with different projects. Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. Report overpayments, underpayments, and other irregularities. Supervise claims adjusters to ensure that adjusters have followed proper methods. Investigate, evaluate and settle claims, applying technical knowledge.
Education
High School Diploma -
Gilbert high school
Anaheim, CAAssociate of Science -
Moreno Valley College
Moreno Valley, CA01.2020
Skills
- Office Ally, EZ-CAP, IDX, Future vision (computerized claims), EDI, Word, Excel, Jwalk(MC 400), ten key, typing
Timeline
Medical billing
ETS Express Trans System
01.2019 - 2025
Claims examiner II
Nautilus (Greater Newport Physicians)
11.2008 - 01.2012
Claims Examiner
Western Medical Management
01.2004 - 01.2008
Claims examiner
Prospect Medical Management
12.1998 - 01.2004
Claims Examiner
Promise Care Medical Group
2024 - Current
High School Diploma -
Gilbert high school
Associate of Science -
Moreno Valley College