Elizabeth Ann Walters

11827 Knotty Pine Trail

Houston, Texas 77050
281-459-2644
281-639-8215
Email address annwalters50@yahoo.com

I am actively seeking a long term position which would allow me to use my skills
in the field of insurance by sharing my knowledge with others and to continue t
o grow and learn with new work experiences. I am a very dedicated individual wit
h good work ethics.

Career Summary:
Thirty six (36) years of experience in processing medical and dental claims for
large self-funded and risk groups along with Medicare.
Extensive knowledge of Medical Terminology including CPT codes – procedural terminol
ogy, ICD-9- description of diseases, HCPCS codes –Medicare Level II codes. Includi
ng knowledge of ADA codes for dental services.

Work Experience:
1996-July 1, 2009 Coventry Health Care, Inc Formally First Hea
lth (Houston, Texas)
Supervised an organized team of cross-functional team members to meet or exceed
service requirements. Managed staff development and work standards. Knowledge
of health care products under fully insured and self-funded with the ability to
maintain production levels and quality goals. Supervised member service employ
ees.
Identify and implement process improvements, encourages ownership of and group p
articipation in the improvement initiatives.
Examine and analyzes the team’s performance against measured service operation goals
, demonstrate ownership for overall team results, recommend and lead the impleme
ntation of plan(s) action to improve the team’s service level.

* Investigate, evaluate and settle claims, applying technical knowledge and huma
n relations skills to effect fair and prompt disposal of cases and to contribute
to a reduced loss ratio.
* Adjust reserves or provide reserve recommendations to ensure that reserve acti
vities are consistent with corporate policies.
* Resolve complex, severe exposure claims, using high service oriented file hand
ling.
* Maintain claim files such as records of settled claims and an inventory of cla
ims requiring detailed analysis.
* Verify and analyze data used in settling claims to ensure that claims are vali
d and that settlements are made according to company practices and procedures.
* Examine claims investigated by insurance adjusters, further investigating ques
tionable claims to determine whether to authorize payments.
* Contact or interview claimants, doctors, medical specialists, or employers to
get additional information.
* Confer with legal counsel on claims requiring litigation.
* Supervise claims adjusters to ensure that adjusters have followed proper metho
ds.

1980-1996 Philadelphia Life Insurance

Formally Great Southern Life Insurance Co (Houston, Texas)
Processed and released PPO, Non-PPO medical groups along with HMO.
Processed and released Medicare claims.
Processed Dental claims for ASO and Risk Groups
* Review insurance policy to determine coverage.
* Prepare insurance claim forms and related documents and review them for comple
teness.
* Provide customer service, such as limited instructions on proceeding with clai
ms or referrals to auto repair facilities or local contractors.
* Organize and work with detailed office or warehouse records, using computers t
o enter, access, search and retrieve data.
* Post or attach information to claim file.
* Transmit claims for payment or further investigation.
* Contact insured or other involved persons to obtain missing information.
* Calculate amount of claim.
* Apply insurance rating systems.
1974-1980 First Continental Life Insurance (Houston, Texas)
Researched complaints and responded to client and provider needs.
* Prepare written opinions and decisions.
* Review and evaluate data on documents, such as claim applications, birth or de
ath certificates, and physician or employer records.
* Research and analyze laws, regulations, policies, and precedent decisions to p
repare for hearings and to determine conclusions.
* Confer with individuals or organizations involved in cases to obtain relevant
information.
* Recommend the acceptance or rejection of claims or compromise settlements acco
rding to laws, regulations, policies, and precedent decisions.
* Authorize payment of valid claims and determine method of payment.
* Determine existence and amount of liability according to current laws, adminis
trative and judicial precedents, and available evidence.

Computer Skills:
MS Office (Word, Excel, PowerPoint, Outlook, IDX. Direct Provider.com, Microsof
t Access, Avaya. CEI-COB, CBSA-Flex, Pend Database, Workflow, ADP-Payroll, Novel
l, Comp-Net, People-safe, Web-apps, OneSource, Internal Audit database. MS-DOS.

Education:
Graduate of M.B. Smiley High School (Houston, Texas)
Microsoft Excel 2003
Microsoft Access 2003
Footprints: Leaders guide to Respecting Others
Leadership: Conducting Effective Focal Reviews
Completed Corrective Action Course
Completed Performance Coaching Course
References available upon request.