Years Experience Insurance
Resume:
P amela S. Denton
Belvidere, I l l inois 61008
SUM MARY OF QUAL I F ICAT IONS:
** *****-********** ** **********-consisting of:
4 years in office administration
3 years experience in Trust Operations
Organized and attentive to detail, handle routine work with consistent accuracy. Positive,
p rofessional and helpful demeanor.
EXPER IENCE:
10/2000 to I N DE M N I TY/POS/POE/PPO CLA I MS TECHN IC IAN
7/2009 Dean Health Plan (DHP), Madison, Wisconsin
P rogressed from Basic Claims, to Medicare/COB, to Benefit Limi tation, then POS
P rocessing of various types of insurance plan claims
U niversity Hospital and Mayo Clinic providers claims
Repricing and processing of out of area claims on the internet
T he repricing and billing for Wisconsin claims
C laim reversals, refund request letters and late charges
Coordination of benefit and Medicare claims
Resolution of disputed discounts and claim issues
P rocessing and management of t ransplant claims/files.
Set up t ransplant files in Excel.
8/1999 to BASIC CLA I MS TECHN IC IAN (D HP)
9/2000 P rocessing of H MO claims
Health Service (special instruction claims)
I n terest, late charges and re-submitted claims
C laim reversals and refund request letters
5/1998 to SUBROGATION SPEC IAL IST (DHP)
8/1999 I nvestigation and follow-up on claims where a third party may be liable
M anaged between 300-400 cases, updating each monthly
H andled phone calls, correspondence and Summons and Complaints
Worked with Attorneys to settle cases
A pplied settlements to cases then closed them
5/1996 to SUBROGATION/REFUND SPECIAL IST
4/1998 Medical Benefit Administrators (MBA) Madison, Wisconsin
M anaged subrogation files
Researched, investigated and followed-up on claims where a third party may be liable
A ttempted to settle cases prior to sending to an outside fi rm
P repared cases when an outside fi rm was utilized
Settled cases and applied to claims, figuring our administrative costs and the fi rms
Set up subrogation files in Excel
P rocessed and requested refunds
Deposited checks into various accounts
I n December of 1996 Premium billing was added to the position
T his consisted of individual billing of over 500 members
I nvolved daily deposits, balancing and the posting of payments with a monthly
i nvoice billing cycle
7/1995 to M ED ICAL REV IEW ASSISTANT (MBA)
4/1996 P re-certified members for third party administrator for 285 different groups
Ran reports and certification letters of confirmation
B illing for PPO repriced claims
U pdated system for termination and acquisition of new TPA’s
I n May of 1996 this position was t ransferred to our corporate office and I was offered the
Position of Refund/Subrogation Specialist (please see above)
5/1991 to TRUST OPERAT IONS ADM I N ISTRAT ION
7/1994 H ar ris Bank, Bar r ington, I llinois
M anaged $88 million dollars in Federated Money Market Funds
Balanced funds daily, placing t rades to cover the sweep t rades
I nput daily factors creating spreadsheet to reconcile monthly interest
Deposited and balanced interest
Monthly, quar terly dividends and capital gains
Batched department work for posting
Developed and improved various department forms, letters and reports
I nventoried and updated vault files
I nventoried stocks and bonds in the vault
Took stock buys and sells over the phone, purchasing or selling Money Market Funds to
offset t rades
P repared and distr ibuted monthly, quarterly and yearly t rust reports
P repared check requests
Tax preparation
I nventoried and ordered department supplies
B illing
11/1988 to PAYMENT PROCESSOR
5/1991 F irst Card,
Westfield, I l linois
P rocessed payments on 10 key Unisys computer, averaged 14,000 keystrokes per hour
SOFTWARE/CLASSES: Lotus, Word Perfect, Federated Edge, Repricing, Outlook, Excel and Word,
M edical Terms, Negotiation Skills, Better Letters and Memos,
B usiness Basics, Insurance Terminology
10/29/09 Completed Excel In termediate refresher class
01/03/10 Credit Report available upon request
Contact this candidate