DONNA GARON
Iselin,New Jersey
Summary
Adept at claims investigation and multitasking, I significantly enhanced claims processing efficiency at CCMSI and QualCare Inc. My keen attention to detail and advanced computer skills led to a notable improvement in case resolution speed and accuracy, demonstrating a strong ability to meet and exceed employer expectations with a proactive and achievement-focused approach. I’m a motivated professional who thrives in team environments. I enjoy working with others to solve problems, share ideas and achieve goals together. I am always ready to support my colleagues and contribute to the team’s success.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Medical Only Adjuster
CCMSI
04.2019 - 06.2024
- Efficiently managed claims and ensured timely resolution of all cases.
- Performed detailed investigations to evaluate liability.
- Maintained strict confidentiality when dealing with sensitive information related to claims processing.
- Assisted customers in filing claims promptly and accurately.
- Utilized advanced problem-solving skills to identify solutions that best met customer needs.
- Corresponded with clients, claimants, and providers to finalize and close claims.
- Contacted or interviewed claimants, doctors, medical specialists, or employers to get additional information.
- Participated in discussion at claim committee meetings.
Medical Claims Examiner
QualCare Inc
11.2011 - 12.2018
- Analyzed patient records to ensure correct coding and billing procedures were followed according to insurance regulations.
- Processed medical claims and ensured accuracy of information provided by doctors, hospitals, and other healthcare providers.
- Reviewed Explanation of Benefits documents from insurance companies for accuracy before submitting them for payment.
- Provided customer service support related to inquiries regarding claim status or payment resolution.
- Performed quality assurance audits on incoming medical claims to ensure compliance with established policies and procedures.
Education
High School Diploma -
John F Kennedy High School
Iselin, NJSome College (No Degree) - Medical Terminology And Coding
Middlesex County College
Edison, NJSkills
- Claims investigation
- Multitasking and organization
- Attention to detail
- Claims processing
- Advanced computer skills
- Medical coding
- Claims investigations
- HIPAA compliance
- Medical terminology
Certification
Delaware Workers Comp License
Timeline
Medical Only Adjuster
CCMSI
04.2019 - 06.2024
Medical Claims Examiner
QualCare Inc
11.2011 - 12.2018
Some College (No Degree) - Medical Terminology And Coding
Middlesex County College
High School Diploma -
John F Kennedy High School
Similar Profiles
Chasity LangeChasity Lange
Head Receptionist/Customer Service at CCMSIHead Receptionist/Customer Service at CCMSI
Nabil OyololaNabil Oyolola
Claim Specialist at CCMSIClaim Specialist at CCMSI
Kedra BirdenKedra Birden
Benefit Analyst at CCMSIBenefit Analyst at CCMSI
Kartika KhandreKartika Khandre
Activity Director at ActivityActivity Director at Activity
Jhalak TejwaniJhalak Tejwani
TEACHER/COACH at Sanjeevani Speaking and Coaching ClassesTEACHER/COACH at Sanjeevani Speaking and Coaching Classes