Matthew Fry
Buffalo,NY
Summary
Detailed claims processor with several years of experience investigating claim information for correctness. Trustworthy teammate with benefit knowledge and rapport-building skills. Noted for thoroughness and ethical customer service.
Experienced in claims processing with solid understanding of insurance procedures and regulations. Strengths include adept problem-solving skills, high level accuracy and comprehensive knowledge of claims management systems. Noted for consistently improving efficiency and reducing errors in previous roles.
Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.
Overview
18
18
years of professional experience
Work History
Customer Service, Claims Processor, Clerical
United Healthcare
Cheektowaga, New York
10.2014 - 09.2023
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
- Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
- Processed a high volume of incoming claims in accordance with established policies and procedures.
- Adhered to all applicable laws, regulations, and company standards while processing claims.
- Researched discrepancies between submitted documentation and actual records to identify errors or omissions.
- Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
- Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
- Documented decisions on each claim based on research findings and applicable benefit plans.
- Assisted customers via telephone inquiries related to their specific claim status or general questions about the company's services.
- Reconciled payment discrepancies between provider statements and remittance advice from payers.
- Managed escalated customer complaints pertaining to denied or delayed payments in a timely manner.
- Provided technical guidance and training to new staff members regarding claim processing procedures.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Reviewed history records to determine benefit eligibility for services.
- Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
- Researched medical claims for validity to resolve discrepancies.
- Coordinated benefits with medical insurance plans and Medicare providers.
- Analyzed contracts and claim systems to apply appropriate benefit amounts.
- Built rapport and trust with injured insureds through effective customer service techniques which involved fair and prompt processing of claims.
- Maintained confidentiality of policyholder information in compliance with HIPAA regulations.
- Communicated with policyholders to explain claim decisions and answer inquiries.
- Collaborated with adjusters and underwriters to resolve complex claim issues.
- Coordinated with healthcare providers to obtain missing information or clarification on claims.
- Determined coverage by examining claim forms and supporting documents.
- Provided training and guidance to new claims processors on department procedures.
Back Room, Electronics, Sales Floor, In Stocks
Target
Amherst, NY
10.2007 - 10.2014
- Received, opened and unpacked merchandise shipments.
- Organized back stock shelves with incoming product.
- Ensured accuracy of inventory levels in the warehouse.
- Stocked shelves with items from back stock area.
- Maintained a clean and safe working environment in the warehouse.
- Operated motorized pallet jacks to move large amounts of product around the warehouse safely.
- Provided excellent customer service while helping customers locate items in the storeroom.
- Greeted customers and provided exceptional customer service.
- Provided accurate information about products, prices and services.
- Maintained up-to-date knowledge of store merchandise and policies.
- Built relationships with customers to encourage repeat business.
- Restocked shelves as needed to ensure sufficient inventory levels.
- Handled customer complaints in a professional manner.
- Upsold additional items based on customer interests and needs.
- Performed cashier duties such as accepting payments, issuing receipts and counting money back change.
- Maintained cleanliness of store environment including floors, windows, displays.
- Helped customers find specific products, answered questions, and offered product advice.
- Engaged customers in friendly, professional dialogue to determine needs.
- Maintained knowledge of current promotions, exchange guidelines, payment policies, and security practices.
- Adhered to company initiatives and achieved established goals.
- Trained new team members in cash register operation, stock procedures, and customer services.
- Adapted sales strategies based on customer interactions and feedback to improve results.
- Greeted customers to determine wants or needs.
- Cleaned shelves, counters and tables to maintain organized store.
- Unboxed new merchandise and restocked shelves in appealing and organized arrangements to promote items.
- Stocked shelves and supplies and organized displays to focus customer attention on specific items.
- Organized store by returning merchandise to proper areas and restocked displays.
- Recommended, selected and located merchandise based on customer desires.
Cashier & Food Prep
Mighty Taco
, NY
10.2005 - 10.2006
- Greeted customers and answered any questions they had about the store's products and services.
- Operated cash register efficiently and accurately, processed payments by cash, check, credit card, gift card or automatic debit.
- Maintained cleanliness of checkout area including countertops, registers, windowsills and floors.
- Cleaned and sanitized work areas, equipment, utensils, dishes, or silverware.
- Prepared ingredients for cooking including portioning, chopping, and storing food before use.
- Stocked service stations with food items such as condiments, salads, desserts, and beverages.
- Checked temperatures of freezers, refrigerators and heated ovens to ensure proper functioning.
- Ensured that all health regulations regarding food handling were followed during preparation process.
Education
Bachelor of Science - Geology
University At Buffalo
Buffalo05-2014
Skills
- Claims review
- Transactions reconciliation
- Payments posting
- Accuracy and Precision
- Medical terminology knowledge
- Eligibility Determination
- Data Entry
- Teamwork and Collaboration
- Customer Service
- Small Claims Payouts
- Insurance Claim Forms Review
- Reliability
- Analytical Skills
- Written Communication
- Professionalism
- Adaptability and Flexibility
- Decision-Making
- Information Verification
- Team Collaboration
- Active Listening
- Documentation skills
- Microsoft Office
- Insurance Coverage Verification
- Payment and Investigation Escalations
- Task Prioritization
- Background in insurance
- Claims Investigation
- Attention to Detail
- Communication Skills
- Fraud Detection
- Conflict Resolution
- Policy Review
- Problem-Solving
Timeline
Customer Service, Claims Processor, Clerical
United Healthcare
10.2014 - 09.2023
Back Room, Electronics, Sales Floor, In Stocks
Target
10.2007 - 10.2014
Cashier & Food Prep
Mighty Taco
10.2005 - 10.2006
Bachelor of Science - Geology
University At Buffalo