Charles Aidan Martin
Summary
Results-driven Claims Examiner at Optum Ireland with expertise in claims adjudication and data analysis. Proven track record in resolving complex appeals and enhancing customer satisfaction through effective communication. Recognized for keen attention to detail and a solution-oriented approach, ensuring compliance and accuracy in all documentation processes.
Overview
38
38
years of professional experience
Work History
Claims Examiner
Optum Ireland
09.2022 - Current
- Medical claims assessment and payment with emphasis on customer care
- Working First Pass Hospital and Physician claims
- Review for discrepancies
- Verify pricing & prior authorization
- Using computer skills daily from updating and inputting data to providing assistance to colleagues experiencing problems
- Handled and processed variety of claims.
- Researched complex billing errors that required an in-depth review of all available documentation before resolution could be reached.
- Processed claims payments and denials in accordance with company procedures.
Appeals Rep SR, Claims Appeals
Optum Ireland
01.2022 - 09.2022
- Reviewing, researching, investigating and resolving appeals and grievances cases
- Communicating with appropriate parties with outcome and solutions
- Analysing and identifying trends in grievances and appeals & reporting to team lead/Supervisor
- Verified that all documentation was complete before rendering a final decision.
- Tracked all phases of the appeals process from intake through resolution.
- Analyzed detailed data associated with each case such as medical necessity criteria and payment history.
- Conducted research on complex cases to ensure accurate resolution of appeals and grievances.
- Assessed appeals and grievances to determine eligibility for reconsideration or review.
Relief Delivery Driver
Fastway Courier Service
07.2020 - 12.2021
- Relief driver for Fastway Couriers delivering throughout Donegal
- Delivered packages promptly to customers by adhering to specified routes and time schedules.
- Maintained accurate logs of deliveries and pickups.
- Sorted parcels according to delivery route.
- Adhered to company policies and procedures, including confidentiality and data protection standards.
- Used cell phones or tablets to upload time, delivery and shipment information into company website or database.
- Collaborated with warehouse staff to ensure accurate and timely dispatch of packages.
- Offered excellent customer service, resolving issues and answering queries at the point of delivery.
- Used GPS navigation to plan routes and rerouted for unexpected delays.
- Completed and submitted necessary fuel, truck inspection and mileage logs and paperwork after each shift.
- Used time-management skills to prioritize urgent deliveries and optimize daily schedules.
Senior Claims Examiner
Optum Ireland
09.2004 - 05.2019
- Reviewed and authorized payments for various types of medical claims.
- Utilized ORS and REVA systems for rework examination.
- Executed accurate upload of provider contracts into management platforms.
- Modified and amended contracts.
- Performed maintenance of provider data.
Service & Parts Sales Administrator
EP Mooney & Co, Nissan Dealership
Dublin
04.2002 - 09.2004
- Handled direct customer interactions in person and by phone.
- Enhanced workflows by troubleshooting complex issues.
- Coordinated inventory procurement.
- Coordinated with Service Department.
- Oversaw processing of monetary exchanges efficiently.
- Maintained adherence to tight schedules.
- Ensured optimal satisfaction in client interactions.
- Performed administrative tasks such as filing documents, scheduling appointments.
- Generated weekly reports on sales performance, analyzing trends and identifying areas of improvement.
- Greeted and assisted customers to foster positive experiences.
- Maximized sales by keeping areas tidy, fully stocked and correctly priced.
- Operated register, handled cash and processed credit card transactions.
- Coordinated with logistics teams to ensure timely delivery of products to customers.
- Managed inventory levels of products available for sale, ensuring that stock is replenished when necessary.
- Processed returns and refunds quickly and efficiently according to established policies and procedures.
Microchip Fabrication Technician
Intel Ireland
Leixlip
02.2000 - 03.2002
- Operated machinery for microchip production on the assembly line.
- Conducted quality control assessments.
- Assembled and completed products according to production schedules.
Service & Parts Sales Administrator
Ken Lawford Nissan Motors
Harolds Cross
07.1999 - 02.2000
- Responded promptly to inquiries ensuring high satisfaction levels.
- Managed inventory purchases.
- Performed financial transactions with accuracy.
- Provided support to in-house mechanics.
Ilkeston Co-op Nissan Dealership
Nottingham
01.1990 - 01.1999
AFG Nissan Dealership
Nottingham
01.1987 - 01.1990
Education
Leaving Certificate -
Skills
- Claims adjudication
- Data analysis
- Regulatory compliance
- Customer service
- Solution-oriented approach
- Keen attention to detail
- Documentation review
- Effective communication
- Critical thinking
- Analytical thinking
Hobbies and Interests
- Sports
- Car maintenance and mechanics
- DIY
Timeline
Claims Examiner
Optum Ireland
09.2022 - Current
Appeals Rep SR, Claims Appeals
Optum Ireland
01.2022 - 09.2022
Relief Delivery Driver
Fastway Courier Service
07.2020 - 12.2021
Senior Claims Examiner
Optum Ireland
09.2004 - 05.2019
Service & Parts Sales Administrator
EP Mooney & Co, Nissan Dealership
04.2002 - 09.2004
Microchip Fabrication Technician
Intel Ireland
02.2000 - 03.2002
Service & Parts Sales Administrator
Ken Lawford Nissan Motors
07.1999 - 02.2000
Ilkeston Co-op Nissan Dealership
01.1990 - 01.1999
AFG Nissan Dealership
01.1987 - 01.1990
Leaving Certificate -
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