Conrad Hylton 123 Fake Street City, State, Zip Code Cell: 000-000-0000 firstname.lastname@example.org
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 Company Name–City, State 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 Company Name–City, State 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 Company Name–City, State 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