Detail-oriented Claims Examiner with proven skills in claims processing, investigative analysis, and healthcare procedures. Committed to enhancing accuracy and efficiency in claims evaluation.
Overview
20
20
years of professional experience
Work History
Claims Examiner
Catalyst Health
Plano, TX
08.2023 - 05.2026
Evaluated and processed claims efficiently, ensuring compliance with company policies and regulations.
Analyzed claim documentation to determine eligibility and appropriate benefit levels based on guidelines.
Researched claims and incident information to deliver solutions and resolve problems.
Collaborated with medical professionals to clarify discrepancies in claim submissions and enhance accuracy.
Utilized claims management software to track case progress and update records systematically.
Senior Claim Processing Specialist
NETIMA
Euless, TX
03.2006 - 08.2023
Analyzed claim data to identify trends, informing strategic decisions for policy adjustments and training needs.
Followed up with customers on unresolved issues.
Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
Posted payments to accounts and maintained records.