Richard Davis
Henderson,NV
Summary
Energetic professional with several years of experience in healthcare insurance and employee benefits. Punctual, reliable, and dedicated employee who has always been considered hardworking and a valuable asset by supervisors and peers.
Overview
32
32
years of professional experience
Work History
Culinary Claims Team Lead
MagnaCare
Westbury, NY
10.2025 - 06.2026
- Led team in processing claims and ensuring compliance with industry standards.
- Coordinated team of claims specialists and examiners to ensure accurate adjudication of hospital, physician, and ancillary claims.
- Coordinated workflow to enhance efficiency in service delivery across departments.
- Mentored junior staff on best practices for client interactions and problem resolution.
Culinary Training & Documentation Coordinator
Zenith American Solutions
Las Vegas, NV
08.2019 - 10.2025
- Reviewed, edited, and updated training claims policies to enhance clarity and effectiveness for team members
- Trained and audited claims examiners and customer service representatives to ensure compliance and consistency in operations
- Collaborated with departments to gather and organize project documentation.
Claims Support Specialist
Zenith American Solutions
Las Vegas, NV
11.2017 - 08.2019
- Facilitated communication with culinary client to address all claims-related issues
- Processed refunds, recoupments, and posted subrogation liens
- Coordinated utilization reviews to secure client authorizations
Reinsurance Coordinator / Claims Specialist
ABPA / Zenith American Solutions
Las Vegas, NV
10.2005 - 11.2017
- Managed Stop Loss operations, ensuring compliance and effective claims processing for various clients
- Adjudicated workers comp and subrogation claims, maintaining accuracy and adherence to regulatory standards
- Coordinated Culinary special agreement and LOA claims, facilitating timely resolution and client satisfaction
Claims Examiner
American Benefit Plan Administrators
Las Vegas, NV
09.2003 - 10.2005
- Reviewed claims for accuracy and compliance with policy guidelines.
- Coordinated with healthcare providers to resolve claim discrepancies.
- Adjudicated hospital, physician, ancillary, and dental claims for culinary services.
Benefits Administrator
Cleveland Clinic Foundation
Cleveland, OH
07.1999 - 07.2003
- Plan Administrator of Life Insurance benefits
- Plan Administrator of Savings & Investment Plan (401k & 403b)
- Addressed employee benefit inquiries and resolved issues to enhance employee satisfaction
- Coordinated with service awards, insurance companies, and credit unions to streamline benefit processes
Account Representative
Cleveland Clinic Foundation
Cleveland, OH
07.1997 - 07.1999
- Assisted customers in resolving inquiries and issues to enhance satisfaction and retention
- Adjudicated hospital, physician, and ancillary claims to ensure accurate processing and timely reimbursement
- Payroll deduction for benefit related out of pocket expenses
Reimbursement Specialist / Work Leader
Cleveland Clinic Foundation
Cleveland, OH
09.1996 - 07.1997
- Processed medical billing for hospital, physician, DME, and home health services to ensure timely reimbursement
- Reviewed insurance policies to determine coverage eligibility for services.
- Collaborated with healthcare providers to verify patient information and documentation.
- Trained staff in customer service techniques and insurance verification processes to enhance service quality
Claims Examiner / Customer Service Representative
MassMutual Insurance Company
Westlake, OH
05.1994 - 09.1996
- Adjudicated hospital, physician, dental, and disability claims to ensure compliance with policies and accurate processing.
- Reviewed insurance claims for accuracy and compliance with company policies.
- Provided customer service support, addressing inquiries and resolving issues to enhance client satisfaction.
Education
Bachelor of Science - Health Education & Exercise Science
University of Akron
Akron, OH05-1993
Skills
- Claims adjudication
- Medical reimbursement
- CPT, ICD-10, DRG, and HCPCS coding
- Regulatory and HIPAA compliance
- Medical terminology
- Employee benefits administration
- Client relations
- Computer literacy
- Communication skills
- Leadership and training
Timeline
Culinary Claims Team Lead
MagnaCare
10.2025 - 06.2026
Culinary Training & Documentation Coordinator
Zenith American Solutions
08.2019 - 10.2025
Claims Support Specialist
Zenith American Solutions
11.2017 - 08.2019
Reinsurance Coordinator / Claims Specialist
ABPA / Zenith American Solutions
10.2005 - 11.2017
Claims Examiner
American Benefit Plan Administrators
09.2003 - 10.2005
Benefits Administrator
Cleveland Clinic Foundation
07.1999 - 07.2003
Account Representative
Cleveland Clinic Foundation
07.1997 - 07.1999
Reimbursement Specialist / Work Leader
Cleveland Clinic Foundation
09.1996 - 07.1997
Claims Examiner / Customer Service Representative
MassMutual Insurance Company
05.1994 - 09.1996
Bachelor of Science - Health Education & Exercise Science
University of Akron