Summary
Overview
Work History
Education
Skills
Timeline
Generic

Sarah Jones

Fresno,CA

Summary

Goal-oriented worker with outstanding knowledge of medical claims, contracting, policies and procedures. Proven history of increasing productivity and customer satisfaction. Committed to best-in-class customer service and maintaining professionalism.

Overview

24
24
years of professional experience

Work History

Claims Support Associate

CVS Health
Fresno, CA
01.2018 - 05.2022
  • Adhered to quality and time-sensitive claims and correspondence.
  • Coached employees through day-to-day work and complex problems.
  • Maintained compliance with claim policies and procedures.
  • Screened all claims and claim types for financial risk.
  • Participated in work groups to solve root cause problems.
  • Logged and mailed out provider and members checks and EOB's.
  • Met 100% TAT requirements
  • Managed daily workload

Sr. Claim Benefits Specialist

Aetna
Fresno, CA
11.1998 - 01.2018
  • Processed both professional and facility fees.
  • Resolved issues and inquiries from plan participants regarding health benefits.
  • Screened all claim for financial risk.
  • Managed inventory and backlog.
  • Assisted DMHC during audits.
  • Exceeded daily production
  • 100% Quality
  • Met monthly metrics

Education

No Degree - Health Insurance Specialist

Fresno Institute of Technology
Clovis
04.1998

GED -

Fresno Adult School
Fresno, CA
02.1997

Skills

  • Understanding of Professional and Facility Contracts
  • Special Handling/Stop Loss
  • ICD10
  • DRG
  • Medical Terminology
  • COB
  • Medicare/HMO experience
  • HIPAA laws
  • Financial Risk

Timeline

Claims Support Associate

CVS Health
01.2018 - 05.2022

Sr. Claim Benefits Specialist

Aetna
11.1998 - 01.2018

No Degree - Health Insurance Specialist

Fresno Institute of Technology

GED -

Fresno Adult School

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Sarah Jones