QUALIFICATIONS & SKILLS: Claims Investigation Coverage Confirmation Recorded Statements Provider/Patient Interviews RFI's DOI Complaints Collaboration w/Law Enforcement Case Management Bill Review/Aberrant Billing Patterns Provider License Verification Data Analysis Data Pulls/Clearing Grids Provider Complaints Member Complaints Reporting to State DOI's (All 50 States) RFI's/Subpoena Reporting to State Medical Boards (All 50 States) CPW/P1 & P2 Process Flows Prospective Investigations/Triage Arbitration IME/CME CPT Coding ICD-9 Coding Medical Terminology Anatomy & Physiology Treatment Protocols Microsoft Word Beginners, Intermediate, Advanced Microsoft Excel Mentoring Phantom Investigations Independent Medical Examinations Settlement of Claims Discontinue Benefits Suspend Benefits Insurance Verification Wage Loss Essential Services Claims Funeral Benefits

Highlights:

• Fraud Investigator
• Compliance
• Case Management
• Claim Examiner
• Claims Representative
• Health Care Industry
• Arbitration
• Benefits
• Billing
• Coding
• Complaints
• Computer Aided Software Engineering
• Data Analysis