Fran Dash

Medical Claims Adjudicator (11/01/1979 – 06/30/2010)

Over 30 years of service as a Medical Claims Adjudicator

Last Employer: Health Insurance BC/MSP

Contact Person: Diane Foort 250 405 3742

Responsibilities: Adjudicates health claims for payment. Maintains strict rules on privacy and confidentiality. Independently reviews and adjudicates complex or specialty claims and provides training to lower level Claims Adjudicators. Determines whether to deny or pay claims within established policies and procedures. Analyzes and answers inquiries regarding claims adjudication, including payment or reason for denial. Adjusts claims that have been denied, overpaid or underpaid. Routes claims requiring additional information or high-level decision-making. Researches claims and appeals as needed. Requests information from internal or outside sources to ascertain completeness of claim. Corresponds with doctors office or other medical facilities with explanation of payment. Review requests for surgery that may be deemed cosmetic and either authorize or refuse request

Accomplishments: I have maintained a healthy relationship with health care professionals. I have gained a wealth of knowledge in the medical field and can communicate effectively

Establishment: Saint Agnes Senior Secondary School for Girls

Details: I was educated in Liverpool, England and successfully completed high school