Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

Teri Cookman

Scarborough,ME

Summary

I have worked in the insurance industry since 1988.

I am a very self motivated, hard working person, and I value my strong relationships with clients.

Overview

36
36
years of professional experience

Work History

Claims Account Manager - Stop Loss Claims.

Unity Re, LLC.
11.2023 - 03.2024
  • Reviewed claims to determine eligibility, work status, and disclosure along with reviewing treatment plans for claimants to confirm if the treatment is medically necessary, and also if chemotherapy regimens, and prescription medications are FDA approved for the claimant's diagnosis codes provided.
  • Reviewed claims to determine if they should be sent out for additional discounts, or possible subrogation. If so, sent claims to the appropriate audit, or subrogation company.
  • Confirmed that claims were being paid appropriately per the Stop Loss Policy and Plan Document.
  • Paid, pended, or denied claims based on claim determination. If over my dollar threshold, I would sent to Gerber for approval.
  • Sent emails to brokers, clients, etc. requesting additional information needed for the claims.
  • Set a reserve in the system after finalizing the claim for all future claims in the present plan year.
  • Sent follow up emails on missing information at 30, and 60 days. Denied claim after 90 days if the additional information previously requested had not been received.
  • Reviewed Plan Documents for new groups, and notated information missing, and needing to be requested before the Plan Document can be approved from a claims standpoint.

Health and Risk Solutions Claims Analyst

Sun Life
10.2018 - 10.2023
  • Maintained strict confidentiality with all personal data as per company guidelines.
  • Analyzed, and paid, or denied claims on on a daily basis after reviewing the Stop Loss Policies, and Plan Documents.
  • Viewed claims regularly to make sure processing was conducted efficiently.
  • Interacted with clients and employees, which helped cultivate positive working relationships.
  • Maintained claims for special groups assigned to me.
  • Mentor to new hires.
  • Organized, and led weekly meetings with a group of my peers.
  • Did periodic installation calls for clients.

Stop Loss Claims Analyst

ASG Risk Management, Inc./ Blue Cross Blue Shield
11.2007 - 10.2018
  • Worked on medical claims from the ground up determining eligibility, reviewing case management notes, and reviewing claims to confirm they are paid correctly.
  • Sent claims out for review due to possible overcharges on billed, and paid claim amounts.

Claims Analyst/Benefits Enrollment Specialist

Anthem Blue Cross Blue Shield
09.1992 - 07.2007
  • Gathered information to determine claim eligibility, and processed medical claims
  • Worked closely with claims, membership, billing, sales, and underwriting departments to get claims processed efficiently.
  • Mentor to other claims analysts.

Workers Compensation Claims Technician

Sedgewick James Insurance
10.1989 - 05.1991
  • Prepared, and submitted forms to claimants, attorneys, insureds, and the workers compensation commission.
  • Calculated and issued weekly compensation checks to claimants.


Workers Compensation Claims Clerk

Hanover Insurance
06.1988 - 10.1989
  • Completed forms to be sent to the companies in which the claimant's worked for, the claimant's, and the workers compensation commission.
  • Issued weekly compensation checks to the claimants.

Education

High School Diploma -

Herndon High School
Herndon, VA
06.1984

Skills

  • Customer Satisfaction
  • Document Workflow
  • Special Projects

Additional Information

I enjoy doing walks to benefit the Maine Veterans Home, The Kerryman Cancer Foundation, St. Judes Childrens Hospital, The Multiple Sclerosis Foundation, The Ronald McDonald House which supports families with critically ill children at Maine Medical Center, and any other foundations.

I am a very active member of The Maine Golden Retriever Club, and was the director of the club for six years.

Timeline

Claims Account Manager - Stop Loss Claims.

Unity Re, LLC.
11.2023 - 03.2024

Health and Risk Solutions Claims Analyst

Sun Life
10.2018 - 10.2023

Stop Loss Claims Analyst

ASG Risk Management, Inc./ Blue Cross Blue Shield
11.2007 - 10.2018

Claims Analyst/Benefits Enrollment Specialist

Anthem Blue Cross Blue Shield
09.1992 - 07.2007

Workers Compensation Claims Technician

Sedgewick James Insurance
10.1989 - 05.1991

Workers Compensation Claims Clerk

Hanover Insurance
06.1988 - 10.1989

High School Diploma -

Herndon High School

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Teri Cookman