1. ANTOINE (TONY) F. SCIACCA
1556 Roosevelt Avenue
Bohemia, New York 11716
(631) 432-5193
tsciacca52@aol.com
CLAIMS MANAGER
SUMMARY
An accomplished and highly skilled Claims Manager with extensive and progressive
experience, focusing on Medical Claims, encompassing hospital and medical staff.
Demonstrated capabilities include developing and implementing work process improvements,
maintaining and exceeding quality standards and excelling in customer satisfaction surveys.
Additional strengths in staff training motivation and supervision. A resourceful, detail and
results oriented team contributor, who excels in performance through both team and individual
efforts.
Computer proficiency includes MS Word, Excel and Access.
PROFESSIONAL EXPERIENCE
HealthCare Partners, Garden City, NY 2008-2016
Claims Supervisor
• Supervised daily activities of 11 Professional Claim Adjudication Analysts.
• Monitored Claims workflows, as well as inventory and lag reports. Adjusted daily
workloads as needed to meet unit goals.
• Reviewed daily production reports, assuring staff is meeting established production
standards. Took corrective action plans, as needed.
• Trained and coached Professional Claim Adjudication Analysts regularly regarding claims
Adjudication. Effort led to above average performance appraisals.
• Adjudicated complex claims in accordance with company established Claims Adjudication
policies and procedures.
• Monitored pending claim reports. Investigated and resolved issues and processed claims as
needed, ensuring timely claim payment.
• Assisted in the resolution of eligibility, benefit, contracting and payment schedule issues.
• Prepared routine reports for Claims Management staff, regarding productivity, claim
inventory, error rates and other reports as requested.
Antoine F. Sciacca Page 2

2. PROFESSIONAL EXPERIENCE (continued)
HealthCare Partners (continued)
• Monitored staff during overtime (evening and weekends) scheduling as necessary to
successfully maintain compliance standards.
• Handled escalated telephone and written communications.
• Conducted internal audits on professional and hospital claims.
• Identified proactively through auditing and internal reporting, negative and positive trends
and initiated recommendations for change as necessary.
• Analyzed computer reports and made necessary corrections or adjustments.
• Followed-up on any problems or questions related to the audit results.
• Maintained audit database for the purpose of departmental evaluation.
• Assisted with the preparation of external audits as needed.
Grout Line Solutions, St. Augustine, FL 2004-2008
Manager/Co-Owner
• Cleaned and resealed grout lines with permanent color finishes.
Royal Health Care, Islandia, NY 2003-2004
Claims Supervisor
• Generated daily inventory and production reports in meeting deadlines.
• Analyzed aging and pending reports and distributed work to the examiners accordingly.
• Monitored claim examiners attendance, punctuality and quality assurance results.
• Interviewed candidates for claim examiner and clerical support positions,
• Compiled results for annual performance appraisals and held meetings with the staff.
• Reviewed claim processing and automated letter generation procedures and implemented
enhancements, when necessary.
• Analyzed and adjusted medical claim authorizations and referrals, as needed.
• Researched and developed Policy and Procedure for Medicare guidelines, via the Centers for
Medicare Services (CMS) Website.
CERTIFICATION
Health Insurance Association of America
Flexible Benefits Coordinator
Customer Satisfaction Skills @ LIU
Train the Trainer
EDUCATION
Long Island University, Brooklyn, NY
Completed college courses, focusing on Healthcare