Brandy Anderson
Omaha
Summary
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes.
Overview
7
7
years of professional experience
Work History
Adjuster II
Guarantee Trust Life Insurance
10.2024 - 10.2025
- Analyze medical records, itemized bills, admission/discharge summaries, and supporting documentation to validate eligibility for daily confinement, ICU, ER visits, and surgical benefits.
- Verify accuracy of ICD-10, CPT, and HCPCS codes to determine payment amounts and ensure proper claims handling.
- Calculate benefit payouts based on policy terms, including per-day hospital benefit, observation stay, and critical illness riders.
- Identify inconsistencies, incomplete documentation, or potential fraud/waste/abuse indicators and escalate or investigate as required.
- Request additional information from members, providers, or facilities to complete claim adjudication.
- Maintain high levels of accuracy, productivity, and compliance with HIPAA and internal quality standards.
- Collaborate with Legal, SIU, and Medical Review teams to address questionable or high-risk claims.
Referral Clerk
Prairie Quest Consulting
08.2023 - 08.2024
- Verify patient eligibility, insurance benefits, and referral requirements prior to scheduling appointments.
- Communicate with physicians, specialists, hospitals, and patients to ensure timely and accurate referral completion.
- Enter referral information, clinical notes, and authorization details into the electronic health record (EHR) or practice management system.
- Track referral statuses, follow up on pending requests, and ensure specialists receive necessary documentation.
- Maintain accurate, HIPAA-compliant records and uphold patient confidentiality at all times.
- Assist patients with questions regarding referral status, required documentation, and specialist instructions.
- Collaborate with front office, billing, and clinical staff to support efficient patient flow.
Med Sup Claims Examiner
Physicians Mutual Insurance
07.2018 - 04.2023
- Analyze medical documentation, itemized bills, and EOBs to determine claim eligibility and appropriate benefit payments.
- Verify accuracy of ICD-10, CPT, and HCPCS codes to ensure proper claim processing.
- Identify discrepancies, duplicates, or potential fraud/waste/abuse and escalate when necessary.
- Communicate with providers, members, and internal teams to clarify information and resolve claim issues.
- Document all claim decisions clearly and accurately within the claims processing system.
- Apply complex benefit calculations, deductible tracking, and crossover claim rules for accurate payment determination.
Education
No Degree - Business
Metropolitan Community College
Omaha, NEHigh School Diploma -
Omaha North High Magnet
Omaha, NE05-2013
Skills
- Claims investigation
- Policy interpretation
- Critical thinking
- Claims processing
- Medical Terminology
- Team collaboration
Timeline
Adjuster II
Guarantee Trust Life Insurance
10.2024 - 10.2025
Referral Clerk
Prairie Quest Consulting
08.2023 - 08.2024
Med Sup Claims Examiner
Physicians Mutual Insurance
07.2018 - 04.2023
No Degree - Business
Metropolitan Community College
High School Diploma -
Omaha North High Magnet