Nelson R. Rayburn
123 Fake Street
City, State, Zip Code
Dependable and professional Medical Claims Processor with 10+ years experience in processing and coding claims, ensuring all required criteria are met before eligible payments go out. Track record of meeting targets through significant knowledge of medical and insurance industries and terminologies, and appropriate and accurate coding. Ready to use skills for high level of customer service for companies and clients.
- Auditing for overpayments
- Management disputes
- Claims adjustment
- Funds recovery
- Quality assurance
- Daily, weekly, monthly reports
- Proficient with claim processing software
March 2007 to Present Company Name, City, State Medical Claims Processor
- In five years, thorough investigation into claims uncovered fraud and potential fraud that saved the company close to $400,000.
- Adjudicate for deductible provision.
- Process claim forms.
- Manage and distribute co-pays, co-insurance maximums and provider settlements.
- Take claims information, log them into system and generate reports.
- Conduct regular audits of random claims for purposes of quality assurance.
- Investigate and resolve settlement issues.
March 2002 to January 2007 Company Name, City, State Medical Claims Processor
- Processed assigned claims.
- Inspected apt allocation of deductibles, co-pays, co-insurance and reimbursements.
- Resolved issues involving customer complaints and claim adjudications.
- Investigated overpayments and funds requirements.
- Kept record of phone calls.
2006 University of California, City, State Bachelor of Arts, Heath Care Management