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RssKARYL HALL

KARYL HALL 413 Merritt Avenue NE (425) 888-3012 (h) North Bend, WA 98045 (425) 246-9856 (c) KBN1122@centurytel.net QUALIFICATIONS Extensive Benefit Administration Background: Deep knowledge of insurance law, subrogation, self-funded insurance plans, COBRA, HIPAA and ERISA requirements. Proven ability to convert health plan details into computer database programs. Strong background with ADA / CPT / ICD-9–CM / STD standards documents. Keen Problem Solving Skills: Known as a creative troubleshooter. Able to quickly identify and resolve customer problems. Often the “go-to” person for difficult clients. Stellar reputation for quality service, satisfaction, and compassion. Attention to Detail: Possess a strong eye for detail. Enjoy statistical analysis. Strong track record for delivering accurate reports and meeting constant deadlines. WORK EXPERIENCE ASSOCIATION SERVICES OF WASHINGTON, Seattle, WA 1996 – 2009 Washington Employers Trust (WET) Senior Customer Service Representative /Subrogation Specialist (2005-2009): Approved subrogated interests and coordinated benefits, working with attorneys and other insurance carriers to ensure smooth repayments. Determined validity of claims by working with consultants and written statistics. Key Accomplishments: • Effectively handled the accurate accounting/repayment of over $500,000 in refunds each year. • Annually composed error-free and timely statistical reports to the Board of Trustees. • Worked closely with department heads to insure turnaround time and accuracy levels. Claims Auditor-Trainer (1996-2005): Hired to assist in creating internal dental, vision and short term disability claim processing department. Acted as primary claims auditor-trainer for all claims processed, including A/R, collections, refunds and voids. Troubleshot difficult issues regarding claim providers and clients. Key Accomplishments: • Created dental, vision and short term disability computer plan builds to enable claim processing for this start-up department as needed. Built elaborate excel spreadsheets. • Trained all new claims processors and customer service representatives in the use of new Rims/ QicLink programs. SERVICE GROUP OF AMERICA (SGA), Seattle, WA 1994 – 1996 Client Service Specialist: Handled questions, from an employee population of 3,000, concerning eligibility and personal claim payment issues for this company’s self funded medical, dental, vision, and short term disability health plan. Prepared multiple reports including turnaround and statistical to insure accuracy and fair employee coverage. Key Accomplishment: • Quickly gained the respect and trust of co-workers for the ability to provide complete, confidential and accurate plan payment information as well as insight into recommended wellness programs.   LINCOLN NATIONAL LIFE, Seattle, WA 1982 – 1996 Lead Claims Adjudicator: Supervised 16 adjustors. Processed medical, dental, vision and short-term disability claims. Worked with new PPO organization (Ethics NW) at start-up phase. Worked with new TPA (CoreSource) as the Short-Term Disability Specialist for the Costco contract. Worked closely with dental consultants and medical advisors to accomplish tasks with accuracy and timely turnaround. Key Accomplishments: • Chosen, out of 132 adjustors, to coordinate the closure of the Seattle claims office, created a smooth transition for 350 employers to 26 different claim offices. • Secured 1,500 new medical providers for new PPO organization. Obtained long term contracts with saving discounts for both patients and insurance carrier. • Negotiated multiple high dollar contract discounts saving the insured and company thousands of dollars. • Reduced “Days Absence Rate” of STD claimants by 20% by aggressively obtaining light duty assignments. EDUCATION AA, Accounting and General Business, Northwest Business College, Lima, Ohio General Education in Business and Accounting (9 quarters), Ohio State University, Columbus, Ohio RELATED TRAINING and CERTIFICATIONS HIPPA Certification Medical Terminology Class Certification “Microsoft Excel 2007”, Washington Employers (2008) “Communicate from Strength”, Washington Employers (2008) “Hold the Phone… It’s a Customer Calling” Washington Employers (2007) “Effective E-mail to Customers” Washington Employers (2007) “Credit and Collections”, Washington Employers (2008) “Time Management”, Washington Employers (2008) “What’s the Color of Your Desk?” Washington Employers (2006) “Giving and Receiving Constructive Feedback”, Washington Employers (2006) “First Aid/ CPR Certified Training”, Washington Employers (2000) Recertification (2005) “Leadworker Effectiveness”, Washington Employers (2001) “Dealing with Difficult Customers Over the Phone”, Washington Employers (2005) COMPUTER SKILLS Proficient with MS Office, Excel 2007, Word, Rims, Qiclink and all Trizetto formats References upon request

Claims Adjuster

North Bend, WA

About Me

Industry:

Insurance

Occupation:

Claims Adjuster
 

Education level:

Associate

Will Relocate:

Yes

Location:

North Bend, WA

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