PROFILE

To obtain a position working in healthcare field, where I can maximize my excellent communication, negotiation,& organizational skills by the ability to work one-on-one with customers to determine requirements and provide support.

SUMMARY OF QUALIFICATIONS

Over 9 years experience with Anthem & Humana working in Individual,Medicare,Medicare Supplement,Medicare Advantage,Medicare Part D,Customer/Provider Service,Enrollment and Billing,Utilization Management and Large Group Case Implementation. I have system experience with CAS, CCP2, Facets, Citrix, Outlook, Marx, Sharepoint, Ultera Imaging, Microsoft Word, Powerpoint, Excel, and Lotus Notes.

EXPERIENCE

Membership Representative I, Anthem Inc Louisville, KY Aug 2010-July2015

Research and key applications to complete the enrollment process. Made outbound calls to brokers/agents and customers for any missing information. Daily pull Incomplete Aging Report from Business Objects,report the inventory and work the report as well. Helped revised the Power of Attorney,Plan Change, and Incomplete Application desk level procedure for the department. Provided maintance on Medicare account including Billing.

Medical Claims Reprocessing Specialist, Humana Inc Louisville, KY Feb 2007-APR 2009

Extensive knowledge of processing corrected and first passed physician and facility claims. Proficient in knowledge of medicare fee schedules and provider contracts research. Analyze medical claims payments for overpayment opportunities. Identify data trends, develop programs to solve problems, and assist in presenting and implementing recommendations and solutions. Provided constant 100% quality from Jan 2008 to April 2009.

Provide liaison role with provider and customer’s claims and information complaints. Proficient in knowledge of medicare advantage plans, prescription drug plans, medicare supplement plans.

Medicare Claims Customer Service Representative, Humana Inc.., Louisville KY Feb 2006-Feb 2007

Taking inbound calls for medicare member, provider, and insurance agent for medicare eligibility, benefits,claims, and enrollment information. I was responsible for answering customers questions, complaints and problems. My training consist of medicare physician & hospital claims, billing & enrollment individual/group, captive and delegated agent support calls, KY teachers Retirement school, medicare supplement, and medicaid training. I processed physician claims up to $500.00 on provider calls. I’ve had constant on medicare guidelines for 2006 to current.

Agent Sales Specialist, Adecco/Humana Inc.., Louisville, KY Oct 2005-Feb 2006

Extensive knowledge of medicare advantage plans, medicare parts A,B,C,&D, and medicare supplement. Provided medicare plan and commission sales support to captive humana agents. Keyed contracting information for delegated agent & contracting pharmacies.

Department Manager, Walmart Inc.., New Albany, IN Apr 2002-Oct-2005

Contributes to the achievement of the paper goods/house chemicals department financial goals by monitoring and evaluating the performance of the department and implementing plans to achieve objectives. Ensuring effective communication and responds to customer questions and paper goods and chemicals merchandise. Demonstrating and utilizes product knowledge about the types of merchandise carried in the paper goods/household chemicals department by providing basic information about the product and products uses. Directs work of associates in department by communicating daily work assignments and instructions on how to perform assigned tasks: review associate work to ensure task are completed: answer questions about merchandise, tasks, or department procedure, and provides feedback to associates on work performance.

Assistance Manager, Meijer Inc.., Jeffersonville, IN Jun 1998-Dec 2001

Extensive knowledge of produce and Bulk foods. Ordered produce and managed department shrinkage for yearly audit. Senior member of season modular team for foods department. Trained new associates for department. Kept produce dept. in top 10 for region sales and sales increase constantly.

EDUCATION

Ivy Tech State College Architectural Drafting

Received an Architectural Certificate

Prosser School of Technology

Technical Diploma in Architectural & Mechanical Drafting