Bryan Fox has over 8 years of experience as a Claims Examiner. He has worked for United Healthcare in Santa Ana, CA since 2009 processing and adjudicating hospital and clinical claims while ensuring compliance with policies, procedures, and regulations. Prior to that, he was a Claims Examiner for Medicaid at Molina Healthcare in Long Beach, CA from 2006 to 2008 where he processed Medi-Cal claims and verified eligibility and pricing. He has skills in medical terminology, coding systems, Microsoft Office, and typing 50 words per minute.

1. Bryan Fox
Long Beach, CA * spirogruf@gmail.com
Summary of Skills
 8 years of Claims Examiner experience
 Knowledge of medical terminology, HCPCS, CPT and ICD-9 codes
 Microsoft Word, Excel & Outlook (2007 and 2010 versions)
 Typing speed: 50wpm and 10-key by touch
Work Experience
Claims Examiner/Claims Associate Rep 03/09 to present
United Healthcare Santa Ana, CA
 Process and adjudicate (Hospital & Clinical) claims complying with company policies and
procedures, state mandates, CMS/Medicare guidelines and benefit plan
documents/certificates
 Patient eligibility research, pricing, prior authorizations, and ensure that proper benefits are
applied to every claim
 Identify and resolve new or unusual claims errors/issues as needed
 Identify claims for fraud, waste and abuse
 Analyze and identify trends then report them to supervisor as necessary
 Claims appeals, reworks, and adjustments
 Follow-up on provider inquiries regarding claim status, underpayments, and denials
 Test new claims processing system prior to its implementation
 Identify/develop/implement new claims processes procedures/solutions fro special handling
requirements
 Handle provider demographic up-dates to claim system
 Work special projects as needed for supervisor
Claims Examiner for Medicaid 04/06 to 06/08
Molina Healthcare Long Beach, CA
 Process and adjudicate (PM160) claims for Medi-Cal complying with company policies and
procedures and California state laws
 Verify patient eligibility, pricing, and ensure that proper benefits are applied to every claim
 Claims appeals and adjustments
 Audit claims for accuracy, underpayment and overpayment
 Assembled denial letter background information and generated denial letters
 Compile claims error reports
 Test new claims processing system prior to its implementation