Gunther Brauner
GRASS VALLEY,CA
Summary
Proven Claims Examiner and Manager at Nivano Physicians, adept in insurance claims processing and quality assurance, enhanced operational efficiency by overhauling claims review processes. Demonstrated exceptional problem-solving and leadership skills, significantly improving team productivity and customer satisfaction. Continuously pursued professional development to stay ahead in industry practices.
Overview
28
28
years of professional experience
Work History
Claims Examiner
Nivano Physicians
04.2018 - Current
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Increased productivity by implementing efficient strategies for handling high volumes of medical claims daily.
- Kept up-to-date on current industry practices, attending workshops and training sessions to continuously improve professional skills.
- Reduced errors in claim submissions by meticulously reviewing patient information and verifying insurance eligibility.
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Processed insurance payments and maintained accurate documentation of payments.
Claims Manager
Nivano Physicians
01.2004 - 04.2018
- Collaborated with other departments to improve overall organizational effectiveness in addressing client needs.
- Enhanced customer satisfaction with timely and accurate claims resolutions.
- Implented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
Managed a team of adjusters, providing coaching and performance feedback for improved productivity. - Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Documented and communicated timely claims information while supporting accurate outcomes.
- Developed training materials to ensure consistent handling of claims across the department.
- Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes.
- Improved claims processing efficiency by implementing streamlined workflow procedures.
- Mentored new hires on company policies/procedures enabling them to quickly become proficient in managing claims.
- Oversaw regular audits of claim files ensuring accuracy in reserve amounts and adherence to established guidelines.
- Maintained compliance with industry regulations during all stages of the claims process.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Prepared weekly check runs.
- Prepared and conducted Annual Health plan Audits.
- Prepared monthly timely reports.
Claims Examiner
Sierra Nevada Medical Associates/
05.1997 - 01.2004
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
- Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.
- Served as a mentor to junior examiners, sharing expertise and providing guidance on best practices within the field of claims examination.
- Assisted in the development of training materials for new Claims Examiners, fostering a supportive learning environment.
- Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Examined claims forms and other records to determine insurance coverage.
Education
High School Diploma -
Nevada Union High School
Grass Valley, CASkills
- Insurance claims processing
- Quality assurance checks
- Thorough claims reviews
- HIPAA
- Problem-solving abilities
- Reliability
- Decision-making skills
- Time management abilities
- 10- key
Timeline
Claims Examiner
Nivano Physicians
04.2018 - Current
Claims Manager
Nivano Physicians
01.2004 - 04.2018
Claims Examiner
Sierra Nevada Medical Associates/
05.1997 - 01.2004
High School Diploma -
Nevada Union High School
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