Summary
Overview
Work History
Education
Skills
Work Availability
Timeline
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Renee Carbonneau

Kissimmee,FL

Summary

Objective: Dedicated claims professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Overview

25
25
years of professional experience

Work History

Claims Representative III

Unicare Life and Health Insurance/Anthem,Inc
Andover, MA
03.2004 - 04.2021
  • Keyed, priced, and adjusted medical and behavioral health insurance claims according to guidelines (Inpatient, Outpatient and Professional)
  • Daily processing of specialty claims (transplant, acute rehabilitation, skilled nursing facilities, inpatient high dollar
  • Process adjustments received from customer service
  • Research to determine who is primary payer(Unicare, Medicare or COB)
  • Meet quality and production standards
  • Knowledge of medical terminology, ICD-9, ICD-10, CPT and HCPC codes
  • Implement HIPPA Privacy Act as mandated by Federal and State Regulation to assure patient confidentiality
  • Apply correct benefits for Multiple Insurance Plans including Medicare and Non-Medicare Claims
  • Assist associates with questions regarding benefits and claims issues
  • Work on special projects for management
  • Used coordination and planning skills to achieve results according to schedule
  • Used critical thinking to break down problems, evaluate solutions and make decisions
  • Developed and maintained courteous and effective working relationships
  • Used Microsoft Word and other software tools to create documents and other communications
  • Exceeded goals through effective task prioritization and great work ethic
  • Offered friendly and efficient service to customers, handled challenging situations with ease
  • Created plans and communicated deadlines to ensure projects were completed on time

Underwriting Assistant

Fairway Underwriters, Inc
Lowell , MA
06.1995 - 12.2002
  • Reviewed applications for insurance coverage and reports from loss control specialists to determine risks.
  • Entered payments, account information and call logs into system.
  • Calculated group and individual renewal rates based on customers' background, industry and demographic information.
  • Responded to customer requests via telephone and email and effectively answered questions and inquiries.
  • Improved operations through consistent hard work and dedication.
  • Maintained energy and enthusiasm in fast-paced environment.
  • Responded to customer requests for products, services and company information.

Education

Medical Administrative Assistant Program -

CEI

Continuing Ed, Insurance

- Business Administration

Middlesex Community College - Lowell
Lowell, MA

Skills

  • Leadership and People Development
  • Operational Analysis
  • Stakeholder Management
  • Portfolio Management
  • Complex Problem Solving
  • Organizational Development
  • Relationship and Team Building
  • Industry Expertise
  • Oracle PeopleSoft
  • Contract Negotiation
  • Inputting claims
  • Claims
  • Proof of claims understanding
  • Claims handling
  • Claims analysis
  • Claims files management processes
  • Medical claims coding
  • Claims Processing
  • Claims adjustment

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline

Claims Representative III

Unicare Life and Health Insurance/Anthem,Inc
03.2004 - 04.2021

Underwriting Assistant

Fairway Underwriters, Inc
06.1995 - 12.2002

Medical Administrative Assistant Program -

CEI

Continuing Ed, Insurance

- Business Administration

Middlesex Community College - Lowell

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Renee Carbonneau