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Insurance Analyst Resume Samples
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0-5 years of experience
Working on insurance costs with Risk Management:
- Developed an insurance cost model that resulted in an improvement of monitoring savings achieved within EMEA subsequently adopted throughout the organisation.
- Monitored areas providing potential savings opportunity.
- Provided strategic advice regarding work and culture integration.
- Assisted with translation of insurance documents to improve the insurance transition.
- Liaised closely with Insurance Brokers, local Eaton/Cooper and Legal on claims and insurance coverage.
- Responsible for delivering professional and technical advice on insurance section.
10+ years of experience
Reviewed complex insurance and annuity contracts as well as viaticals and discount medical plan organization filings to verify compliance with applicable state statutes and Florida Administrative Code.
- Provided written and verbal guidance to industry to identify deficiencies found in fillings.
- Provided mentorship and training to new analysts based on my leadership, performance and extensive regulatory knowledge and experience.
- Assisted Management with special projects as required.
0-5 years of experience
Monitors and maintains expertise on all guidance and requirements of agencies that regulate medical, insurance licenses and certificates including providing information/updates and technical assistance services as appropriate.
- Establishes and maintains strong relationship with organizations/agencies that regulate policies and guidelines.
- Responsible for sharing related billing, credentialing and FTCA policy changes or updates to staff and health center staff.
- Developed and maintain a reimbursement procedure manual for FQHC’s to utilize to orient new staff.
- Provide on-site technical assistance training to community health center members of the association on billing and CPT correct coding guidelines.
- Insure consistency of distributed messages and materials concerning private and public health insurance agencies.
- Maintaining knowledge of commercial and governmental policy and procedural changes, ensuring the community health center staff is compliant with the changes.
- Credentialing and enrollment services to contracted Federally Qualified Health Centers.
- Primary sources verification of new and existing providers in a timely manner.
- Establish relationship with health plans in addressing credentialing needs to help resolve billing and authorization issues.
- Supervise staff of 3, training and monitoring the credentialing process. Reporting to the health centers the status of providers in the credentialing process. Monitor productivity and escalation issues. Conducting annual performance review.
0-5 years of experience
- Organized certificate of insurance and surety bond programs.
- Logged pollution expenditures for reconciliation.
- Prepared litigation and return to work reports for delivery to third party vendor.
- Tracked and coordinated Auto Schedule for Delek vehicles.
- Handled invoices for brokers and completed requests for escrow funding.
- Ensured strategic objectives of the risk management were met, to include preparation for actuarial.
- Utilized GRA Risk Management claims tracking software.
0-5 years of experience
- Contact Commercial, Medicare, Medicaid and Managed Care insurance payer by telephone or through correspondence to obtain payment status for Pain Management, Home Infusion Therapy, Surgery and Imaging claims that are Out Of Network and Work Compensation and or personal injury Claims.
- Answer incoming A/R inquiries and followed up and documented A/R collection, file proof of claims and handle attorney correspondence
- Filed electronic and paper claims, worked aging report for outstanding account balances that was 120 days and older, appeals on paper and on the phone to insurance companies, that wasn’t processed and paid per their contract or fee schedule. Followed company guidelines and refers accounts to collection agencies and adjusted off bad debt or per insurance discount with manager prior approval. Resolved discrepancies in a timely fashion, establish clear payment schedules to asses accounts to be re-billed due to the wrong carrier, note first report of injury, denied claim to prepare accounts to be written off and turned over to collections agency.
0-5 years of experience
- Meet new business production goals and objectives as established.
- Solicit for new business and grow sales revenue via telephone, email, networking, and other lead sources.
- Develop insurance quotes for auto, house, workers compensation, make sales presentations, and close sales.
- Maintain knowledge of new products and understand underwriting guidelines.
- Work with customers on claims and maintain client relationships with follow up phone calls.
0-5 years of experience
- Review medical insurance claims for completion and accuracy and submit claims for processing
- Correspond with insurance companies to verify claim status until payment obtained
- Utilize various software systems including; Relay Health, Horizon Practice Plus, Excel, Passport, Star Navigation, and McKesson One Content
- Selected as the most recent hire to train new employees
0-5 years of experience
- Underwriting insurance applications of ER physicians for our captive risk retention group
- Querying claims database using SAP Business Objects to answer questions from senior management
- Producing regular loss runs and claims histories to support credentialing processes and to support our actuarial consultant
- Maintaining loss reserves, entering and reporting Expense and Indemnity payments
- Legal reporting to National Practitioner Data Bank (NPDB) of settlements and judgments attributable to our providers
0-5 years of experience
- Analyze insurance benefits, processing and prior authorizations during scope of medication procurement.
- Proficient in insurance billing claims processing, and prior authorizations.
- Communicate with insurance payors and providers to investigate pharmacy and medical benefits.
- Determine patient’s financial responsibilities, quantity limits, and prior authorization or pre-certification requirements.
- Determine medical information requirements and documents required by payors.
- Licensed Pharmacy Technician.
0-5 years of experience
- Process complex life insurance & annuity applications ensuring each case if effective and minimize turn-around time for approval.
- Assist with special projects as needed or as appropriate.
- Generates reports, correspondence and form letters for additional information.
- Document files and follow-ups according to established procedures.
- Follows appropriate procedures to approve and process reinstatement applications, conversions, and policy coverage changes within guidelines.
0-5 years of experience
- Monitor claims outstanding and report daily using various sorts to manage daily claim volumes and timelines according to policy.
- Monitor claim errors by form and report trends, new incidents, duplications, track claims incorrect payer mix and unusual volumes.
- Research and take action on all failed claims to bill or pend on hold for additional information by the end of the import day.
- Follow-up and resolve claims in held status daily.
- Bill secondary claims no less than twice a week.
- Maintain age less than 5 days from import.
- Process 55 to 100 claims addressed per day contingent on assignment.
- Apply claim notes to provide detailed explanation to downstream users when claims are pending corrections.
- Coordinate submission of supporting documentation, e.g., treatment plans, operative reports, EOB.
- EPIC System.
0-5 years of experience
- Make calls, email or fax requests for flood certificates and declarations pages.
- Add information to spread sheet, EGS-WFMC INS, CATS and Strategy.
- Scan documents to file net and attached to files.
- Process mail received from mail room and assist with other duties as assigned.
10+ years of experience
- Reviews, analyzes, and implements all healthcare and benefits requirements
- Processed and audited workers compensation claims according to various medical fee guideline
- Prepare high level user documentation and training materials for upper management
- Communicate with physician facilities to ensure proper verification and coverages
- Develops and executes system strategies to further simplify all claim procedures
- Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance
0-5 years of experience
- Identify payer specific trends
- Act as primary resource to resolve NCCI issues
- Facilitate problem-resolution by providing supporting documentation on trended payer issues
- Ensure clean claim submission by reviewing ICD-10/CPT guidelines
- Review and resolve 90 day AR reports
- Insurance follow-up, denials, appeals
- Monitor revenue cycle to identify/resolve claims not processing appropriately
- Insurance verification, eligibility and benefits
0-5 years of experience
- Investigate companies accused of violating FL insurance regulation
- Utilize several state systems to verify company information
- Research companies that are not complying with the state’s laws and regulations
- Interact with attorneys and company officers to achieve conclusions to the investigations
0-5 years of experience
- Research, and resolve insurance related issues for customers and management.
- Maintain proper insurance record set-up, renewal reviews, and force placed coverage.
- Review commercial loans to ensure compliance of loan documents, servicing contracts, and industry servicing standards.
- Adhere to established timeliness and quality for insurance reporting.
10+ years of experience
- Identify and research medical cost claims for payment status and account closure verification
- Ensure timely follow-up with customers and payers to maximize total dollars collected
- Research claims and account information, document findings
- Assisted guarantors with all aspects of account reconciliation and closure
- Assisted supervisor and manager with peer interviews
- Contacted customers to collect monies owed on past due accounts
- Assisted clients with all aspects of account collection expediting account balance and closure
- Used internet based applications to process invoices, handle inquiries and settle accounts
0-5 years of experience
Pharmacy Technician II
- Investigate patient insurance history
- Obtain prior authorization and appeal forms
- Validate insurance and co-pay information
- Maintain patients confidentially per HIPPA laws
0-5 years of experience
- Verification of patient benefits
- Authorization of surgical procedures
- Patient registration
- Collection of private pay/copayment
6-10 years of experience
- Maintains compliance with state regulatory mandates with various clients
- Works with multiple companies in designing software
- Customer service representative for some of our largest clients
0-5 years of experience
- Daily Responsibilities working in EMDS appointment system and pulling Vamreport
- Working in Excel Sorting, separating and coloring Vamreport
- Verifying Patients Insurance Policy for Deductible, Coinsurance and Out of pocket amount as well as quoting the patients out of pocket amount for services
- Use Verification/ Billing Systems such as Zirmed, Availity, Passport and more
- Responsible for Authorization process via fax or over phone
- Understanding and Identifying each Insurance Guidelines’ and updates
- Working closely with patient care coordinators and Administrator’s
- Answering calls from Insurance companies to overturn an Authorization Denials
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Insurance Analyst
Last edited by: Gabriela Barcenas, CONTENT STRATEGIST -
Gabriela Barcenas
CONTENT STRATEGISTGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
