Manager Medical
Resume:
Elaine Smith
P.O. Box ****
Daytona Beach Shores, Fl 32116
******@*****.***
objective
Approach work in an organized and systematic manner to
effectively meet the emerging business needs of my
organization.
Functional summary
* Links work to goals of the business unit.
* Captures learning from experiences to improve strategic
choices.
* Models integrity and ethical behavior in all situations
* Complies with the laws, regulations and ethical standards
that govern our business.
* Demonstrates resiliency and commitment during times of
change.
Summary of qualifications
Three and a half years of processing Medical
Benefit Claims. Fifteen years clerical and customer
service experience with ten years working in State
Government using Federal, State and Local rules and
regulations. Experienced communicator and effectively
interacts with people of all ages and ethnic
backgrounds. Worked with Non Profit Organizations and
Community Agencies. Quickly adapts and is successful in
learning new systems and methods for job requirements.
Employment
10/06/2012 - Current
Tropic Aire Motel- Property Manager
Show property to perspective guests, Register guests, receive
monies, make deposits and etc.
11/12/2011 - 12/16/2011 -Integrity Staffing
-Outsourced to Amazon
Seasonal Warehouse Associate- Receive and process incoming
merchandise to send to customers.
Elaine Smith Page 2
11/22/2010 - 01/28/2011 - Labor Ready -Outsourced to
RWC- Trucking, Phoenix, AZ
Temporary Helper
Billing and Invoicing using the ADP System.
11/10/2010-11/19/2010-Labor Ready- Outsourced to
Mobile Mini, Phoenix, AZ
Temporary Helper
Data entry into Excel spreadsheet; Pulled, reorganized and
archived files.
08/19/2010-09/15/2010-Xenosoft Technologies(XT-Global)
Outsourced to Mphasis-Phoenix
Business Analyst-Advanced Benefits Responsibilities
Configuring software for client with multiple Health Plans.
04/20/2009-07/02/2010-Aetna (Schaller Anderson),
Phoenix, AZ- Sr. Benefits Claims Specialist/Analyst
Reprocess claims as appropriate to achieve claim accuracy,
proof claim or referral submission to apply appropriate
coding, member identification processes and provider selection
processes; Research and analyze complex healthcare claims,
pharmacy and lab data; Manage COB processes; Perform claim
investigations and resolve or escalate for resolution;
Establish and/or administer provider reimbursement processes;
Process provider claims.
10/15/2008-04/17/2009 - Managed Staffing/Adea Solutions
Temporary Consultant to Aetna (Schaller Anderson)
Identified discrepancies with Call Tracking System Backlog.
Researched and processed claims.
10/15/2007-06/16/2008 - Coventry Health Care, Tucson, AZ
Associate Tech Claims Specialist
Processed Workers' Compensation Claims; Evaluated
bills to determine if and how they should be
paid by the insurance
carrier, Processed paper and/or electronic claims, Reviewed
basic pended bills, Conducted searches to determine
correct processing of bills.
02/20/2007-10/13/2007 - DES/DYFC-CPS, Tucson, AZ
Secretary/Office Receptionist
Assisted Unit Secretaries with Police Reports, Created
Files, Managed Files; Directed all incoming calls and
Routed all incoming and outgoing mail.
Elaine Smith Page 3
09/13/2006-02/02/2007- MesaCAN, Tucson, AZ
Outsourced to United Way of Tucson & So. AZ,
AmeriCorps VISTA
Set up Neighborhood Associations Database, Presented
presentations on the VITA/EITC Program, Set up and installed
Tax Wise software at many VITA sites.
9/17/2000-11/02/2005 GA DOT-Office of Utilities, Atlanta, GA
Secretary 2
Typed Notice of Award Correspondence for Contractors and
Utility Companies, Typed utility and railroad agreements,
Created and maintained files and databases, Maintained
external and internal communications links.
Education
Currently enrolled at Grand Canyon University in the Bachelor
of Science Program with Emphasis in Addiction, Chemical
Dependency, and Substance Abuse.
03/31/05 Brown Mackie College - Atlanta, Georgia
Associate of Occupational Science/ Medical Office Technology
Listed on Dean's List quarterly and graduated with a 4.0 GPA
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