Patricia Burkett
Anderson
Summary
SUMMARY
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
33
33
years of professional experience
Work History
Claims Examiner II Temp @ Partnership Health Care
Express Employment Services
11.2024 - Current
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Examined claims forms and other records to determine insurance coverage.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
Customer Service Representative /Customer Service/Claims
Blue Shield of California
04.2008 - 11.2024
- Promoted high customer satisfaction by resolving appeals and problems with knowledgeable and friendly service
- Uphold quality control policies and procedures to increase customer satisfaction
- Escalated customer concerns, issues and requirements to supervisors for immediate rectification
- Answered inbound calls, chats and emails to facilitate customer service and responded by written correspondence, by phone, or email
- Assisted in training new hires on procedures, best practices and protocols to reduce process gaps
- Adjusted claims to resolve customer issues
- Assisted claims department with the processing of transplant claims
Customer Service/Claims and Medical Review Representative
Considine and Associates
05.2002 - 06.2007
- Complied with confidentiality regulations in handling customer information
- Checked documentation for appropriate coding, catching errors and making revisions
- Prepped documents for medical review and sent to appropriate specialties for review
- Assisted Associates in logging in and obtaining documents for medical review
- Applied basic insurance knowledge to evaluate and analyze information
- Answered insurance-related questions and discussed product offerings with prospective customers to meet unique needs
- Trained new employees
Customer Service/Claims/Medical Review intake Representative
Admar Corporation
04.1998 - 05.2002
- Complied with confidentiality regulations in handling customer information
- Customer Service assisting members in locating network providers and resolving network issues
- Assisted claims department data entry and pricing files for claim processing
- Assisted utilization Management with intake for medical review and case management
Medical records Representative
Redding Medical Center
01.1992 - 07.1997
- Complied with confidentiality regulations in handling Patient information
- Completed medical record requests for surgery, legal request, Patient request, treating provider request, billing office, medical research, and yearly audits
- Assisted the Analyst with chart maintenance ensuring that all required documents and signatures were done, requesting providers to dictate or write required documents and provide signatures as needed
Education
High School Diploma -
Shasta College
Redding, CASkills
- Claims processing
- Data verification
- Policy interpretation
- Customer service and support
- Reliability
- Critical thinking
- Multitasking
- Time management
- Problem-solving abilities
- Teamwork and collaboration
- Coding systems
- Claims adjustment
- Problem-solving
- Attention to detail
- Verbal communication
Timeline
Claims Examiner II Temp @ Partnership Health Care
Express Employment Services
11.2024 - Current
Customer Service Representative /Customer Service/Claims
Blue Shield of California
04.2008 - 11.2024
Customer Service/Claims and Medical Review Representative
Considine and Associates
05.2002 - 06.2007
Customer Service/Claims/Medical Review intake Representative
Admar Corporation
04.1998 - 05.2002
Medical records Representative
Redding Medical Center
01.1992 - 07.1997
High School Diploma -
Shasta College
Similar Profiles
Caleb BerryCaleb Berry
Temporary General Laborer at Express Employment ServicesTemporary General Laborer at Express Employment Services
Christopher PletenikChristopher Pletenik
Forklift Operator at Express Employment ServicesForklift Operator at Express Employment Services
Dakoda CrottsDakoda Crotts
Dock Worker at Express Employment ServicesDock Worker at Express Employment Services