Jennifer Pettit
SEATAC,WA
Summary
Focused Claims Adjudicator actively seeking a Claims Adjudicator role to apply 10 years of claims processing and data verification. Well-versed in investigating claims to verify validity and determining settlements or denials.
Overview
20
20
years of professional experience
Work History
Claims Adjudicator
Sole Provider for Return to Work, MD LLC
Seattle, Washington
01.2019 - Current
- A Medical Only Adjuster is a professional who works closely with professionals to determine the validity of workers’ compensation claims that involve only medical workers’ compensation benefits. Roles and responsibilities - providing customer service, answering telephone calls and redirecting callers as necessary; evaluating coverage and determining compensability; performing data entry to set up new claims, completing and preparing documentation for referrals, managing initial and subsequent treatment with the medical provider network; and assisting in the delivery of medical care in accordance with utilization review, and using appropriate cost containment techniques including strategic vendor partnerships to reduce the overall cost of claims.
- Developed relationships with attorneys, experts and vendors in order to ensure prompt service when necessary.
- Advised management on potential areas of improvement in the claims process.
- Monitored assigned caseloads for timely resolution of claims.
- Managed workflow by prioritizing tasks according to urgency.
Claims Adjudicator I
Archbright
Seattle, Washington
04.2016 - 08.2018
- Experienced Medical Claims Adjudicator with expertise in quickly analyzing documents and data to determine eligibility and courses of action
- Substantial understanding of medical and workers' compensation claims process.
- Identified discrepancies in claim information and requested additional information from claimants.
- Reviewed and processed incoming claims to determine applicable coverage.
- Researched policy language, relevant laws, and regulations to ensure accurate adjudication of claims.
- Analyzed medical records to verify diagnosis codes and services rendered.
- Determined eligibility for coverage based on policy terms and provided explanations of findings to claimants.
Claims Adjuster
Denali Group
Sea-Tac, Washington
07.2012 - 01.2016
- Provided support for the Claims Department, acted as the first point of contact for customers/shippers, assisted with claims resolution, and performed various administrative duties.
Sales Coordinator/Front Desk/Reservations Agent
Hotel Andra
Seattle, Washington
06.2011 - 07.2012
- Acted as a liaison between Reservations, Conference Services, and Sales, managed group reservations, processed check-in/check-out of guests, and provided assistance to guests.
Front Desk Supervisor
Hotel Max
Seattle, Washington
07.2007 - 09.2010
- Managed front desk operations, processed check-in/check-out of guests, assisted guests with various requests, and conducted training for new hires.
Manager On Duty
Warwick Hotel
Seattle, Washington
01.2006 - 01.2007
Front Desk Agent
Coast Bellevue Hotel
Bellevue, Washington
01.2005 - 01.2006
Front Desk Agent
Red Lion Hotel
Bellevue, Washington
01.2004 - 01.2005
Education
Skills
- Insurance Claim Regulations
- Data Verification
- Claims processing documentation
- Claims Processing
- Insurance knowledge
- Policy Interpretation
- Claims Management
- Client Relationship Management
- Investigative skills
- Decision-Making
- Active Listening
- Critical Thinking
- Liability Determination
- Claims Evaluation
- File and Record Management
- Verbal Communication
- Attention to Detail
- Workers' compensation claims
References
- Jessie Forgy, 253-259-7373, Office Supervisor, Return to Work, MD
- Michelle Crevling, 425-445-0743, Claims Manager, Archbright
- Jamie Thompson, 253-249-1536, Supervisor, Denali Group
- Zach Miller, 503-830-9744, Front Office Manager, Hotel Max
- Robert Smartt, 253-961-7369, Front Office Manager, Warwick Hotel
Timeline
Claims Adjudicator
Sole Provider for Return to Work, MD LLC
01.2019 - Current
Claims Adjudicator I
Archbright
04.2016 - 08.2018
Claims Adjuster
Denali Group
07.2012 - 01.2016
Sales Coordinator/Front Desk/Reservations Agent
Hotel Andra
06.2011 - 07.2012
Front Desk Supervisor
Hotel Max
07.2007 - 09.2010
Manager On Duty
Warwick Hotel
01.2006 - 01.2007
Front Desk Agent
Coast Bellevue Hotel
01.2005 - 01.2006
Front Desk Agent
Red Lion Hotel
01.2004 - 01.2005
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