Judith Ross
Bullhead City
Summary
Seasoned Claims Processor evaluating online entry, error correction and quality control review for final adjudication of claims. Strong business and financial acumen with proven success to maintain efficient operations. Extensive knowledge of billing, collections and fiduciary management. Flexible hard worker ready to learn and contribute to team success. Dedicated employee known for punctuality, pursuing employment options where good customer service and positive attitude will make a difference.
Skilled claims processing professional with extensive experience in reviewing and validating insurance claims. Strong focus on accuracy, problem-solving, and effective communication. Known for collaborative approach and adaptability to changing needs. Proficient in claims software, data entry, and customer service. Recognized for reliability and achieving results in team environments.
Experienced with processing diverse insurance claims and ensuring compliance with regulatory standards. Utilizes attention to detail and analytical skills to identify discrepancies and expedite resolutions. Track record of maintaining accurate records and delivering exceptional customer service.
Overview
30
30
years of professional experience
Work History
Claims Processor
Noridian Medicare
04.2023 - 03.2025
- Communicated with claimants to provide updates and manage expectations effectively.
- Supported audits by preparing necessary documentation and responding to inquiries promptly.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Followed up with customers on unresolved issues.
- Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
- Identified fraudulent claims through thorough investigation and documentation of findings.
- Reduced claim processing time for faster customer service and improved satisfaction rates.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Maintained detailed records of all processed claims for easy retrieval during audits or disputes.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Identified and reported potential fraud or abuse related to claims to protect system's integrity.
- Streamlined communication channels between departments for more efficient handling of claim-related inquiries from both customers and colleagues alike.
- Ensured compliance with all regulatory requirements, staying up-to-date with changes and conducting regular training.
- Achieved high levels of customer satisfaction, handling each claim with professionalism and care.
- Reduced backlog of pending claims, prioritizing tasks effectively and efficiently.
- Generated, posted and attached information to claim files.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
Claims Processor
FHAS
12.2021 - 01.2023
- Processed insurance claims efficiently, ensuring compliance with regulatory guidelines.
- Reviewed claim documentation for accuracy and completeness, reducing processing errors.
- Coordinated with healthcare providers to resolve discrepancies and clarify information.
- Utilized claims management software to track progress and maintain thorough records.
- Assisted in training new team members on claims processing procedures and best practices.
- Identified trends in claim submissions, contributing to process improvement initiatives.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Managed workload and priorities to meet claims processing meet deadlines.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
Claims Processor
TMG Health
01.2005 - 05.2005
- Verified claim data correctness in preparation for processing.
- Reviewed history records to determine benefit eligibility for services.
- Researched medical claims for validity to resolve discrepancies.
- Maintained comprehensive database, including enrollment data, claim submission and payment information.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Coordinated benefits with medical insurance plans and Medicare providers.
- Identified client service improvement opportunities in collaboration with team leads and managers to resolve problems.
- Complied with confidentiality regulations in handling customer information.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
Administrative Assistant
Wilkes barre/ scranton visitor's bureau
05.1995 - 05.1996
- Organized and maintained filing and document management systems by coordinating, archiving and purging files.
- Developed administrative processes to achieve organizational objectives and improve office efficiency.
- Handled management of communication to executives by taking and making telephone calls, reviewing and prioritizing mail and composing and typing correspondence.
- Updated details in company database by keying in customer contacts and delivery dates.
- Maintained inventory in supply closet to prevent shortages.
- Coordinated project materials by managing physical and digital files, monitoring spreadsheets and updating reports.
- Directed customer communication to appropriate department personnel.
- Prepared packages for shipment by generating packing slips and setting up courier deliveries.
- Planned events and department activities by acquiring venues, developing guest lists and organizing catering services.
Education
Phlebotomist -
Luzerne County Community College
Nanticoke, PA08.1992
High School Diploma -
Wyoming Area High School
Exeter, PA06.1990
Skills
- Claims review
- Transactions reconciliation
- Regulatory compliance
- Medicaid knowledge
- Outstanding clerical abilities
- Medical terminology
- Accuracy and precision
- ICD-10-cM coding
- Customer service
- Claim denial resolution
- Critical Decision-making
- HIPAA compliance awareness
- Claims
- Medical record review
Timeline
Claims Processor
Noridian Medicare
04.2023 - 03.2025
Claims Processor
FHAS
12.2021 - 01.2023
Claims Processor
TMG Health
01.2005 - 05.2005
Administrative Assistant
Wilkes barre/ scranton visitor's bureau
05.1995 - 05.1996
High School Diploma -
Wyoming Area High School
Phlebotomist -
Luzerne County Community College