Carol Whitacre
West Harrison,Indiana
Summary
Dedicated insurance professional with over 39 years of experience in analyzing medical, dental, and vision claims, conducting plan testing, and performing claim audits. Proficient in processing refunds, voids, and reissues. Expertise in medical claims analysis ensures accurate and timely processing of healthcare claims while maintaining compliance with industry regulations. Strong data management skills and attention to detail foster effective problem-solving and collaboration within teams. Adaptable to changing needs and reliable in high-pressure environments, with a thorough understanding of healthcare regulations and insurance policies that drive results.
Overview
28
28
years of professional experience
Work History
Claim Analyst/ Plan Tester, Quality Assurance Auditor
S&S Healthcare Strategies
Cincinnati, Ohio
10.2000 - Current
- Analyze claims to determine patient liability, make approval or denial decisions in accordance with insurance policy. Audit medical and dental claims to ensure claims are processing accurately. Plan testing of new accounts. Process refunds-void and reissues account payable.
Workers Compensation Claims Adjuster
Sheakley
Cincinnati, Ohio
01.1999 - 10.2000
- Analyzed workers compensation claims. Verified first report of injury for BWC. Customer support for the injured workers to resolve issues.
Patient Account Representative
Medical Recovery Specialist
Cincinnati, Ohio
12.1997 - 01.1999
- Resolve patient accounts by collecting balances and rectifying discrepancies. Updating information and billing insurance. Provide customer support to resolve patient accounts.
Education
High School Diploma -
William Henry Harrison High School
Harrison, OhioSkills
- Analyzed Medical, Dental and Vision claims
- Refunds/void and reissues
- Customer Service
- Managed Claims Reporting
- Stoploss
- Training new hires
- Plan Testing of new groups
- Auditing medical, dental and vision claims
Timeline
Claim Analyst/ Plan Tester, Quality Assurance Auditor
S&S Healthcare Strategies
10.2000 - Current
Workers Compensation Claims Adjuster
Sheakley
01.1999 - 10.2000
Patient Account Representative
Medical Recovery Specialist
12.1997 - 01.1999
High School Diploma -
William Henry Harrison High School
Computers
- Impact
- TEXEN
- Javelina
- Meditech
- MCO Advantage
- IBM Mainframe
- MS Office