
Experienced Senior Claims Representative with a strong track record in claims processing and customer service. Demonstrated expertise in managing complex claims and resolving customer issues, consistently delivering excellent service with a focus on efficiency and satisfaction. Adept at team leadership and maintaining strong client relationships.
• Review and processed medical claims for accuracy, completeness, and adherence to insurance policies and guidelines
• Investigate and resolve complex claim issues by analyzing medical records, policy documents, and billing information
• Identify potential fraudulent activities or billing errors through careful analysis of claims data
• Maintain a high level of productivity while meeting quality standards in processing a large volume of claims daily
• Utilize coding systems such as CPT, ICD-10, HCPCS to accurately assign appropriate reimbursement codes for services rendered
• Assist in the development and implementation of new processes to improve efficiency in claims processing workflow
• Perform audits on process claims to identify trends or patterns that may require further investigation or process improvement
• Maintain accurate documentation of all actions taken during the claims review process for audit purposes