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yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000
xxx-xxx-xxxx
abc@xyz.com

driven professional seeking a challenging position in the insurance industry, where expertise in client services, claims support, and communication will prove instrumental to company success.

---

career profile

 

offer thirty years progressive claim support experience with specific expertise in processing, auditing, and troubleshooting insurance claims. successfully handled all paperwork from preliminary communication with policy holders and third parties. proven ability to investigate competitive policy pricing strategies. solid experience in devising new procedures to enhance company operations. specialized in training, development, and mentoring of new hire staff; resulting in above average retention rate. dynamic communication, presentation, negotiation, and relationship management skills. proven sales ability. highly organized and efficient. extremely capable manager and leader. proficient in all phases of organizing and coordinating insurance claims.

 

~ key achievements ~

monetary star award for outstanding effort, provider services department,

monetary star award for superior service, mt market hub

monetary star award for ability to work with providers, provider contracting department

25% production increase for streamlining the review processes

---

professional experience

 

triwest healthcare alliance                                                                                                                                                            2005-present

field representative

  • successfully lead 20 educational seminars for tricare service providers.
  • effectively rotate through 360 arizona/utah providers and military bases; update clients on new products, plan terms, and entitlements.
  • consistently participate in pseac meetings at military commands
  • manage provider needs, plan troubleshooting, audit disputed claim issues.

claims manager

  • effectively collaborated with claims analyst in support of claims issues.
  • responsible for products and services; managed weekly performance audits, including claims review, documentation, and follow up.
  • successfully supervised and organized daily work flow, scheduling, and client support.  

pacific life and annuity                                                                                                                                                                            1996-2005
advance medical claims analyst

  • effectively process medical, dental and vision claims; specific knowledge of anatomy, physiology, dsm, cpt, and icd9 codes.
  • successfully apply contract limitations and company guidelines to all claims; ensure adherence state legislation, phi, hippa.
  • maintain effective quality and production standards at all times to provide superior customer service.

technical claims analyst

  • effectively provide support to claims processing staff and all aspects of pacific life products.
  • successfully applied industrial standards of medical and health care treatment to specific medical conditions and diagnosis.

 

royal oaks life care center                                                                                                                                                                     1994-1996
human resources support staff/insurance resources liaison

  • successfully provide help support by fielding questions and concerns; provide claim resolutions.
  • collaborated with third party administer to resolve claims issues for both patients and providers.
  • efficiently handle negotiations of high dollar claims to reduce out of pocket cost to the patients.
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education

 

clark community college pre-nursing classes

portland community college nursing assistance certificate

portland state university core classes
phoenix college emt certificate, healthcare management classes
university of phoenix business management
glendale community college
business management

united states navy hospital corpsman training


yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000
xxx-xxx-xxxx
abc@xyz.com

 

date

 

 

 

hiring agent name

title

company name

address

city/state/zip code

 

dear__________________:

 

i am currently seeking a challenging career opportunity as an insurance specialist and am submitting my resume for your review.  in advance, thank you for your time and consideration.

 

as demonstrated in the accompanying resume, my professional qualifications include over fourteen years experience in insurance claims. to complement this background, i offer dynamic communication, product presentation, negotiation, and client service skills.

 

as an employee, you will find me to be a driven team player committed to supporting you in achieving your objectives through superior performance.  i am confident that i could be a valuable asset to your firm, and look forward to interviewing with you in the near future.

 

sincerely,

 

 

 

 

 

 

 

yyyyyy x. yyyyyy
 

 

 

 

 

 

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