TERESA HEATH
Mooresville,IN
Summary
Dedicated health insurance professional with more than 23 years of experience processing, including Medicare and Medicaid claims. Knowledgeable in interpreting policies and co-ordination of benefits, medical terminology and surgical procedure codes. Effectively manage multiple, high-priority projects and take pride in providing exemplary customer service. Collaborative individual with expertise in providing exemplary service regarding benefits support. Multitasking Benefits Specialist knowledgeable in state and federal regulations and maintaining employee confidentiality.
Overview
23
23
years of professional experience
Work History
Senior Claims Benefits Specialist
Aetna/CVS Health
08.2018 - Current
- Administered short term health insurance policies with a pre-existing condition clause and hold for investigation of pre-existing diagnoses or process for payment utilizing multiple computer platforms and databases
- Met or exceeded company goals.
- Full understanding of HIPAA
Claims Examiner
HCC Medical Insurance Services
06.2014 - 07.2017
- Examine/Research claim cases for pre-existing conditions, which requires policy knowledge for each individual state, state by state mandates, exclusions and riders
- Making determinations on payment of claims
- Utilizing extensive medical terminology knowledge by pouring over large volumes of medical records on a daily basis.
Claims Examiner
Aerotek Staffing Company For Tokio Marine HCC
02.2014 - 06.2014
- Examine/Research claim cases for pre-existing conditions, which requires policy knowledge for each individual state, state by state mandates, exclusions and riders
- Making determinations on payment of claims
- Utilizing my extensive medical terminology knowledge by pouring over large volumes of medical records on a daily basis.
Claims Processor
Anthem-Wellpoint, Inc.
12.2001 - 09.2012
- Administered over 500,000 claims throughout my tenure
- Provided optimum service to policyholders
- Analyzed claims to determine extent of company's liability
- Took initiative and worked under minimal supervision as a work-at-home associate for nine years
- Learned several computer platforms utilizing multiple databases
- Consistently met or exceeded company goals
- Full understanding of the Health Insurance Portability and Accountability Act.
Medical Transcriptionist
McGood Medical Transcription
03.2001 - 12.2001
- Full time position, working from home utilizing my PC to type physician dictated operative and procedural reports for Community Hospitals of Indiana.
Education
Skills
- Excellent oral and written Communication
- Learn quickly
- Professional Telephone Etiquette
- Work independently to completion
- Policy Interpretation
- Confidential Records Management
- Claims Reports and Documentation
- Good computer skills
- Timely Adjudication of Claims
Timeline
Senior Claims Benefits Specialist
Aetna/CVS Health
08.2018 - Current
Claims Examiner
HCC Medical Insurance Services
06.2014 - 07.2017
Claims Examiner
Aerotek Staffing Company For Tokio Marine HCC
02.2014 - 06.2014
Claims Processor
Anthem-Wellpoint, Inc.
12.2001 - 09.2012
Medical Transcriptionist
McGood Medical Transcription
03.2001 - 12.2001
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