Conrad Hylton 100 Broadway Lane New Parkland, CA, 91010 Cell: (555) 987-1234 email@example.com
Detail-oriented Medical Claims Examiner, well versed in health insurance statutes, regulations and practices. Excellent communication skills that serve to lessen claimant confusion about process and status. Adept at multi-tasking and completing assignments within any and all policy and statutory prescribed deadlines.
Command of medical insurance claims laws
Proactive solution finder
Effective team member
July 2010 to October 2012 Happy Valley Insurance–New Cityland, CA Medical Claims Examiner
Provided front line claims settlement services for second largest health insurance carrier operating in California.
Increased claims processing efficiency by over 20% during time with insurer.
Resolved consumer initiated claims disputes with a 65% overall success rate, eliminating the need for expensive claims appeals.
Developed and presented monthly reports on claims processing and settlement activity.
October 2012 to January 2014 Big-O Health Insurance–New Cityland, CA Medical Claims Examiner
Implemented company-wide claims processing efficiency protocols in the aftermath of the implementation of the Affordable Care Act.
Coordinated team of 12 claims examiners attached to the Affordable Care Act.
Oversaw preparation of materials for claims appeals lodged by insureds.
Trained new claims examiners hired by company.
January 2014 to Present Gigantic Insurance Company–New Cityland, CA Senior Claims Adjuster
Liaison between claims adjustment team and senior management regarding all claims related issues associated with the Affordable Care Act.
Responsible for training new claims examiners and for implementing ongoing training and continuing education programming associated with the Affordable Care Act.
Presented at industry conferences on claims settlement and the Affordable Care Act.
Developed unified company-wide claims reporting system associated with the ACA Marketplace related claims.
2010 University of Florida, Hot Beach, FL Bachelor of Arts, Business Administration