Marcia St Vry
Brooklyn,NY
Summary
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes.
Overview
7
7
years of professional experience
Work History
Senior Claims Examiner
United Health Group, Optum
01.2021 - Current
- Coordinated with medical professionals to obtain necessary documentation for evaluating injury claims accurately.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- 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.
- Identified fraudulent activities by analyzing patterns, trends, and discrepancies in medical claims data.
- Researched and resolved complex medical claims issues to support timely processing.
Tier 2 Sr Claims Advocate
United Healthcare
11.2019 - 12.2020
- Worked productively in fast-moving work environment to process large volumes of claims
- Sought out new clients and developed client relationships through networking, direct referrals, lead databases and cold calling
- Examined reports, accounts and evidence to determine integrity and accuracy of information
- Interviewed policyholders to verify information and obtain additional details
- Evaluated accuracy and quality of data entered into agency management system
- Proposed settlements for uncomplicated issues to resolve claims.
Patient Care Coordinator
Jamaica Hospital Medical Center
02.2017 - 11.2019
- Acted as main point of contact for patients, doctors and hospital staff by closely reviewing medical charts and maintaining high levels of communication
- Delivered excellent patient experiences and direct care
- Maintained confidentiality of patient data and condition to safeguard health information
- Worked with patients and families to develop future plans and discuss care actions
- Educated patients by explaining preparation instructions for upcoming procedures and tests
- Upheld confidentiality requirements and regulatory compliance guidelines
Education
Bachelor Of Health Science -
University of Hartford
West Hartford, CT05.2019
Skills
- MS Office
- Insurance claims processing
- Basic negotiation and conflict resolution skills
- Intermediate written and verbal communication skills
- Active Listening
Timeline
Senior Claims Examiner
United Health Group, Optum
01.2021 - Current
Tier 2 Sr Claims Advocate
United Healthcare
11.2019 - 12.2020
Patient Care Coordinator
Jamaica Hospital Medical Center
02.2017 - 11.2019
Bachelor Of Health Science -
University of Hartford
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