Summary
Overview
Work History
Education
Skills
Accomplishments
Additional Information
Timeline
Stella Hunsaker

Stella Hunsaker

Independence,MO

Summary

Claims Adjuster with deep experience in confidential medical claims. Superbly positioned to investigate, evaluate and set process all types including speciality claims. Excellent abilities to decipher fraudulent activities, analyze data, confer with SIU communicate with to gain details for processing claims. Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes.

Overview

44
44
years of professional experience

Work History

Senior Claims Adjuster

GEHA
12.1998 - Current


  • Examines hospital and physician claims for processing.
  • Examines all types of areas in specialties in claims such as SIU, NSA, RTC, IDT, Medicaid, Air Ambulance, Obra and all other types of roles to process.
  • Handles task for reviewing of adjustments of claims and releasing, and any other problem-solving of the task to be completed for our member.
  • Reviews escalated member emails that are sent from customer care to resolve the claim issues to be processed or adjusted.
  • Knowledge in excel for special projects of claims to be further process or adjusted or denied.
  • Knowledgeable and regular adjustments, and two day adjustments for claims.
  • Knowledge and facets 360
  • Knowledge and reviewing, and recognizing fraud with providers and report to lighthouse if suspicious
  • Examines correspondence from members and providers and solve or sent a letter on issues.

PDM

GEHA
12.1998 - 12.2002
  • Examined provider in members claims for provider, addresses, and remittance
  • Add a new providers for the company to the system
  • Investigated if provider was PPO or non-par

Enrollment File Clerk

GEHA
12.1998 - 12.2000


  • Maintained physical and computer-based filing systems.
  • Sorted and classified documents into appropriate filing systems for increased traceability
  • Assisted with document scanning and imaging projects

Paraprofessional

Fort, Osage District Early Childhood
08.1996 - 07.1998
  • Delivered personalized educational, behavioral, and emotional support to individual students to enable positive learning outcomes.
  • Oversaw students in classroom and common areas to monitor, enforce rules, and support lead teacher.
  • Assisted in maintaining engaging and respectful educational environment by promoting discipline and cooperation.
  • Kept classrooms clean, neat, and properly sanitized for student health and classroom efficiency.

Bookkeeper

Boatmen's Bank
08.1982 - 03.1991
  • Maintained and processed invoices, deposits, and money logs.
  • Completed payroll for employees and maintained detailed records of procedures.
  • Tracked expenses and income for businesses while organizing and maintaining bank statements for checking accounts.
  • Reconciled and corrected issues with financial records.

Cashier and sales person

Sears
Kansas City, MO
01.1980 - 06.1982
  • Skilled at working independently and collaboratively in a team environment.
  • Self-motivated, with a strong sense of personal responsibility.
  • Proven ability to learn quickly and adapt to new situations.

Education

High School Diploma -

East High School, Kansas City, MO
05.1982

Skills

  • Complex Claims
  • Medical Terminology for reviewing claims before processing
  • Service Quality
  • Spreadsheet Tracking
  • Microsoft Office
  • Payment and Investigation Escalations
  • Project Requirements
  • Claims Preparation
  • Claims
  • Professional Development
  • UM Authorization Processing
  • Training to my peers for specialty claims, and regular claims for trainees and other associate adjusters
  • Adjustments and 2 day adjustments
  • Solving issues and adjusting or paying claims sent through our customer care tasks
  • Recognizing fraudulent providers and reporting to lighthouse
  • Processing of all types of specialty claims as follows NSA , SIU, OBRA, RTC , IDT, Medicaid, and all other hospital and medical roles

Accomplishments

  • Registered an average of 23 claims per hour and above , exceeding company targets.
  • Maintained a superior quality rating of 97% and above exceeding the 97 and above % department goal every year of service.
  • I collaborate across the enterprise to ensure to provide the best customer care to our members. My involvement with SIU projects, promotes the environment of sharing ideas and supporting GEHA goals to improve, processing in the organization
  • Always prepared to engage with supervisor on one on one meetings, and to provide feedback on issues with claim processing that may be effect to GEHA, efficiency
  • I my work, ethics and time management skills I have proven in all my evaluation reviews to be of the most excellence.
  • I excellent accuracy and have achieved all OPM and member. Focus metrics and met goals for accuracy ratings
  • Outstanding audits results during the review period
  • Achieved 97 % and above by completing customer service tasks with accuracy and efficiency.
  • Documented and resolved provider and member issues which led to resolving the task.
  • Resolved product issue and testing for previous software, and processing claims throughout the years.
  • Used Microsoft Excel to develop inventory tracking for past due claims.
  • Trained outsource adjusters that GEHA has hired to process specialty claims.
  • Trained trainees in the claims department, when released from training class and mentored them further.
  • Answered Questions, through other departments and pears on difficult claims.
  • Volunteered and joined ERG disability through GEHA.
  • Completed Linkedln classes, and excel classes on Microsoft teams and in training classes throughout my career at GEHA.
  • Completed all compliance training.
  • I have volunteered for mothers refuge and sleepyhead mattresses to serve our community on behalf of our organization
  • I have volunteered at the Kansas City Chiefs stadium to pass out headbands on behalf of our organization.
  • Participated in GEHA a corporate challenge in the past and GEHA a 5K at the Chiefs stadium.

Additional Information

I am a hard-working individual with high expertise in processing all types of hospital and medical claims. I am an excellent team player and believe this is important in any company or corporation, and to better serve our members. I have excellent reviews in my production and quantity and quality of claims. All reviews for GEHA and past employment are all for excellence.

Timeline

Senior Claims Adjuster - GEHA
12.1998 - Current
PDM - GEHA
12.1998 - 12.2002
Enrollment File Clerk - GEHA
12.1998 - 12.2000
Paraprofessional - Fort, Osage District Early Childhood
08.1996 - 07.1998
Bookkeeper - Boatmen's Bank
08.1982 - 03.1991
Cashier and sales person - Sears
01.1980 - 06.1982
East High School - High School Diploma,
Stella Hunsaker