Josh Roberts

Experience

• 

  Nationwide Financial

  Apr 2014 - May 2015

  Territorial Management Representative

  General Duties:• Logistically managed the territory and rotation for 6 of Nationwide’s Regional Vice President.• Maintained key relationships with some of the largest independent financial advisors.• Prospected and set-up annuity sales, and retirement plan opportunities in FL, GA, TN, NE, MO, OKOR, and WA territories.• Provided customer service in high volume call center environment.• Maintained excel spreadsheets for assigned National wholesalers to report and trend their top 200 financialadvisors• Utilized reporting of excel spreadsheets to complete transactions Show less

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  Nationwide

  May 2015 - Jun 2019

  - Investigate and resolve commercial property, liability and/or commercial Auto claims according to Best Claims Practices.-Identifies potential suspicious claims and refers to Special Investigation Unit (SIU) and identifies for third partysubrogation.-Make Effective use of loss management techniques. Negotiates settlements with attorneys /claimants.- Arrange expert inspections involving third party or potential fraud actions as needed.-Determine appropriate treatment based on compensable injury by utilizing IES system and on-going medicaltraining.-Provide on-your-side customer service by contacting policy holders, and third parties within24 hours and following up in a timely manner.-Provided customer service in high volume call center environment. Show less General Duties:-Manages, investigates and resolves claims. Investigates and evaluates coverage, liability, damages, injuries and handles settlements for third party customers and attorneys.-Identifies potential suspicious claims and refers to Special Investigation Unit (SIU) and identifies for third partysubrogation.-Make Effective use of loss management techniques. Negotiates settlements with attorneys /claimants.Arrange expert inspections involving third party or potential fraud actions as needed.-Determine appropriate treatment based on compensable injury by utilizing IES and on-going medicaltraining.-Provide on-your-side customer service by contacting policy holders, and injured third parties within24 hours and following up in a timely manner.-Provided customer service in high volume call center environment.Financial management:-Analyze injury and policy limits to calculate settlement offer-Calculate pain & suffering and lost wages for claimant-Review and analyze medical bill charges (both professional & hospital)-Provide all checks to claimants and/or providers Show less • Evaluated and Investigates First Party Medical Claims.• Made payment decisions based on policy provisions, state mandates, departmental policies,medical and non-medical information in accordance with best claims practice• Determined appropriate treatment bases on the compensable injury by utilizing tools such asAIS (Nationwide medical billing system) and on-going medical training.• Provided on-your-side customer service by contacting the injured party within 24 hours andfollowing up in a timely manner.• Provided customer service in high volume call center environment.• Reviewed and analyze medical bill charges (both professional & hospital)• Calculated and provide payment to payee’s for claimant’s professional & hospital medical bills• Provided all checks to claimants and/or providers Show less

  • Commerical Casualty Adjuster

    Oct 2018 - Jun 2019

  • Claims Bodily Injury Adjuster

    Jan 2017 - Oct 2018

  • Medical Claims Specialist

    May 2015 - Jan 2017
• 

  Duke University Health System

  Jul 2019 - Jan 2022

  -Oversee the collection of outstanding accounts receivable for Government payors.-Review and analyze accounts receivable data, advising PRMO leadership conclusions and recommendations.-Create and implement strategies to increase the number of successful collections on outstanding claims.-Recruit, Hire, Train and evaluate staff members within the collections department to ensure a sufficient number of staff members are available to handle the workload.-Develop goals that complement the overarching business goals of the company and coordinate staff too continually meet and exceed goals.-Run reports and analyze data pertaining to the department and share with PRMO leadership. -Implement policies and procedures that retain a smooth running department based on our daily functions. Show less - Coordinate, prepare and analyze denials for technical services. Review and analyze trends, advising leadership regarding conclusions and recommendations. - Prepare written reports and analyses for leadership highlighting trends and appropriate recommendations/conclusions.- Serve as an expert resource to leadership in the decision-making process. Played an integral role in implementing and managing and change related to area of expertise- Act as a technical resource to operational management and staff on the appropriate interpretation of denials. Show less

  • Patient Account Revenue Manager

    Mar 2021 - Jan 2022

  • Denials Analyst

    Jul 2019 - Feb 2021
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  Conifer Health Solutions

  Jan 2022 - now

  Patient Account Manager

  -Oversee the collection of outstanding accounts receivable for commercial, managed care and Medicare advantage payers.-Review and analyze accounts receivable data, advising leadership conclusions and recommendations.-Create and implement strategies to increase the number of successful collections on outstanding claims.-Recruit, Hire, Train and evaluate staff members within the collections department to ensure a sufficient number of staff members are available to handle the workload.-Develop goals that complement the overarching business goals of the company and coordinate staff too continually meet and exceed goals.-Run reports and analyze data pertaining to the department and share with leadership. -Implement policies and procedures that retain a smooth running department based on our daily functions. Show less