Joshua Welcome
Averill Park,NY
Summary
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 5 years of insurance experience.
Overview
8
8
years of professional experience
Work History
Claims Representative
CDPHP
10.2020 - Current
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
First Pass Claims Approver
Emblem Health
10.2019 - 10.2020
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations
- Reviewed provider coding information to report services and verify correctness
- Used administrative guidelines as resource or to answer questions when processing medical claims
- Paid or denied medical claims based upon established claims processing criteria
- Evaluated accuracy and quality of data entered into agency management system.
Verification Documents Administrator
Maximus
06.2017 - 10.2019
- Select materials needed to complete work assignments
- Locate and correct data entry errors, or report them to supervisors
- Compare data with source documents, or re-enter data in verification format to detect errors
- Handle consumers protected information Verify the information attested to in a consumer application to verify the accuracy of the information on the account Use excel calculate attested incomes Leave detailed notes as to what actions were taken on an account.
Retail Sales Associate, Retail Sales Worker
PetSmart
08.2016 - 07.2017
- Receive payment by cash, check, credit cards, vouchers, or automatic debits
- Issue receipts, refunds, credits, or change due to customers
- Establish or identify prices of goods, services or admission, and tabulate bills using calculators, cash registers, or optical price scanners
- Greet customers and ascertain what each customer wants or needs
- Maintain clean and orderly checkout areas and complete other general cleaning duties, such as mopping floors and emptying trash cans
- Assist customers by providing information and resolving their complaints
- Describe merchandise and explain use, operation, and care of merchandise to customers
Education
High School Diploma -
Averill Park High School
Averill, NY07.2014
Skills
- Microsoft Excel
- Insurance Claims Review
- Claims Investigation
- Policy understanding
- Attention to Detail
- Medicaid knowledge
- Data Entry
- Policy Knowledge
Timeline
Claims Representative
CDPHP
10.2020 - Current
First Pass Claims Approver
Emblem Health
10.2019 - 10.2020
Verification Documents Administrator
Maximus
06.2017 - 10.2019
Retail Sales Associate, Retail Sales Worker
PetSmart
08.2016 - 07.2017
High School Diploma -
Averill Park High School