Verna Sixkiller

Sr. Claims Examiner

Cognizant Technologies

Phoenix

03.2012 - Current

Reviewed complex claims to ensure compliance with company policies and regulations.
Analyzed claim submissions for accuracy and completeness, identifying potential issues.
Collaborated with internal teams to resolve discrepancies in claim processing.
Adjusted reserves to maintain consistency with established operational and risk guidelines.
Reviewed specific and aggregate claims and consulted with clients to assess completeness and compliance.
Approved payment requests based on established guidelines and criteria.
Participated in meetings with senior management personnel to discuss policy changes related to claims adjudication.
Advised junior staff members on technical aspects of adjudicating difficult cases.
Paid and processed claims within designated authority level.
Reviewed claims to ensure accuracy, resulting in multiple claim reductions.
Analyzed and audited open claims to calculate additional payments owed.
Examined claims investigated by independent adjusters.
Researched and followed up on denied insurance claims.
Double-checked and reviewed documentation for denied and accepted insurance claims.
Handled and processed variety of claims.
Evaluated acceptability of claims from third-parties and gathered comprehensive information.
Developed and implemented strategies to reduce claim processing times.
Managed caseload effectively, ensuring timely review and resolution of claims.
Provided excellent customer service, resolving claimant concerns and queries promptly.
Maintained up-to-date knowledge of regulatory changes affecting claims processing.
Conducted secondary evaluations of original investigations documentation and reports to facilitate smooth resolutions.
Utilized knowledge of medical terminology to ensure accurate coding for billing purposes.