Customer Service Manager

Susan L. Portas, FLMI

*** ********* ******

SAINT LOUIS, MO 63122

home 314-***-****

cell 314-***-****

*******@*********.***

EMPLOYEE BENEFITS CLIENT EXECUTIVE

. Experienced group healthcare manager

. Relationship building, Client advocacy

. Proven leadership and organizational abilities

. Strong liaison and troubleshooting skills

EXPERIENCE

Claims Analyst II

Perico Life Insurance Company/HCC Insurance Company - 2009-2010

. Audited excess loss reinsurance claims; stop loss for self-funded

groups

. Skilled in audit procedures, plan document/SPD interpretation, claims

experience analysis, computation of complex levels of benefits

. Specific stop loss and Aggregate stop loss review and calculation.

Maintained 99.9% audit accuracy.

. Oral and written communications with third party administrators,

internal customers and vendors regarding claims settlements

. Identified large claim potential; referred to case management, set

risk reserves for future liability.

Department was moved to Atlanta; St. Louis office closed

Operations Manager, BPO

Emdeon Business Services- 2005-2008

. Directed the Business Process Outsourcing for mailroom and document

imaging services

. Opened a new office; set up workflows, created production and quality

assurance procedures, documented Best Practices, trained personnel,

managed budgets, capital purchases

. Project Management, process improvement

. Managed projects, analyzed reports and resolved clients' problems.

Assured that client imaging TATs (turnaround times) were met. Met

service level agreement requirements

. Ran this branch office independently of the Nashville, Tennessee

headquarters

Largest client merged with Anthem and cancelled services; office was closed

December 2008

Claims Manager

Westport Benefits/Century Planners - 2004-2005

. Managed Claims Department of 40+ including home payers, in-house

benefit specialists, auditors, trainers and supervisors

. Assured that performance standards and TATs were met

. Coordinated department functions with customer service, eligibility,

legal, IT, and client service departments

. Provided leadership, conducted meetings, distributed information, and

maintained staff morale.

Office Manager

BeneSys, Inc, - 2004

. Managed a Fringe Benefits office at a union hall

. Oversight for processing of Taft-Hartley regulated health, dental,

vision and life claims; contributions; work hour tracking; reciprocity

calculations; retirement pension and annuity administration

. Managed monthly COBRA mailings

. Prepared materials for board meetings and authored union newsletter

articles relative to fringe benefits.

Senior Account Representative

Trustmark Insurance Company - 2000-2003

. Service after the sale; contact for group administrator, brokers,

consultants

. Install group, review materials for accuracy, submit to underwriters

. Coordinated renewals, plan change recommendations, benefits evaluation

. Provided reports, interpreted plan language, reviewed accuracy of

contracts, SPDs and ID cards and other deliverables

Associate Director, Benefits

Trustmark Insurance Company -1982-1999

. Managed a Claims and Customer Service Department of 50+ employees to

meet company goals and expectations and reported to Lake Forest,

Illinois home office

. Knowledge of fully insured, self- funded, ASO, HSA, Life, Disability,

Dental, FSA

. HR functions, training, compliance, budgeting, strategic planning,

high level claim reviews, development of production and quality

metrics

. Personnel development, wrote job descriptions, executed performance

evaluations, job enrichment programs, skills training

. Grievance and appeals handling, court appearances and depositions

. Answered insurance department complaints on behalf of the company's

CEO and President.

General layoff and reductions in work force in 2003

PROFESSIONAL DESIGNATIONS

Industry related Professional Designations through Life Office Management

Association (LOMA), Health Insurance Association of America (HIAA), and

International Claims Association (ICA):

o FLMI - Fellow, Life Management Institute

o HIA - Health Insurance Associate

o ALHC - Associate, Life and Health Claims

o ACS - Associate, Customer Service

o MHP - Managed Health Professional

o ARA - Associate, Reinsurance Administration

o AIRC - Associate, Insurance Regulatory Compliance

o AIAA - Associate, Insurance Agency Administration

SKILLS

. Proficient in Office 2010; Word, Excel, PowerPoint, Outlook

. Experience on various claims processing systems and web applications:

ClaimFacts/Trizetto, Eldorado, AS400, Ceridian, Kronos, Seibel,

Oracle, PeopleSoft

. Project Management; meeting deadlines

. Budgeting, Accounting, Purchase & Requisition

. Business Letter Writing courses

. COBRA administration, Medicare and Medicaid administration,

Subrogation

. Workers Compensation, OSHA, HIPAA, ERISA, TEFRA, FMLA

. Fraud Training, Privacy Training, Security Training, Civil Treatment

(Diversity) Training

. Medical Terminology, HIPAA certified

. Medical Coding familiarity, CPT, HCPCS, ICD9, DRG, NPI

Contact this candidate