Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Lowen Karnes

El Paso,TX

Summary

Dependable medical claims expert with 7+ years of first-hand experience in processing Hospital and Physician claims. Verify member information and provider information for accurate claims processing with a high level focus on quality. Able to Demonstrate ability to communicating with management and auditors in a timely and polite manner. Along with 8+ years of management experience, writing schedules, ordering product and supplies, allocating the correct resources to maintain a positive work environment for employees. Currently working toward the FAA part 107 drone operator commerical license. Proficient are drone/camera operation on small drone platforms.

Overview

17
17
years of professional experience

Work History

CPA - Claims Processor

United Healthcare
02.2025 - Current
  • Processed claims accurately, ensuring compliance with company policies and regulatory requirements.
  • Reviewed documentation for completeness, identifying discrepancies to minimize processing delays.
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Evaluated accuracy and quality of data entered into processing system

Hospital/Physician CPQ Processor and Auditor

United Healthcare
10.2017 - 02.2025
  • Processed Hospital and Physician claim, verify member information for 100% accuracy
  • Entered claims data into the system.
  • Resolved problems resulting from claim missing information
  • Performed audits of randomly selected claims to ensure quality processing.
  • Return claims to providers to have claims corrected for accuracy and quality processing
  • Verifying that provider information is correct, including addresses and provider type E.g. Family practice, radiology etc.

Fuel Station Manager

Albertsons/Vons Inc
10.2008 - 10.2016
  • Maintaining a quality customer service experience for new and returning customers.
  • Managing various personality types for a smooth efficient positive work environment.
  • Ordering product and reviewing weekly sales to better market product for better sales results
  • Annually exceeded sales projections
  • Scheduling employees work shifts weekly. Making last minute changes when an employee calls out.
  • Build rapport with various vendors to get better communication and set up new product campaigns.

Education

Associate of Science - Computer Science/Water Technology

Mount San Jacinto College
05-2016

Skills

  • Medical Terminology
  • CPT codes and ICD-9 codes
  • Excellent communication skills
  • Outstanding telephone etiquette
  • Practical interpersonal skills to handle several inquiries in a diplomatic manner
  • Ability to provide professional customer service in stressful situations
  • Ability to remain calm in stressful situations with customers
  • Outstanding ability to empathize with employees to better run a business or department with careful and firm decision making
  • Claims processing software
  • Accuracy and precision
  • Claims review
  • Drone/Camera Operator FAA Approved, Working on Part 107 For commercial drone license

Accomplishments

  • Above company standard for quality for 6 years running.
  • Certified in M&R Levels 1 and 2
  • Covid claim processing project during pandemic.

Timeline

CPA - Claims Processor

United Healthcare
02.2025 - Current

Hospital/Physician CPQ Processor and Auditor

United Healthcare
10.2017 - 02.2025

Fuel Station Manager

Albertsons/Vons Inc
10.2008 - 10.2016

Associate of Science - Computer Science/Water Technology

Mount San Jacinto College

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