Customer Service Life Insurance

Cindy M. Horne (Personal & Confidential)

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

Nampa ID 83687

208-***-**** (H)

208-***-**** (C)

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

http://www.linkedin.com/in/cindyhorne

http://www.cmhorne.wordpress.com

Professional Experience

Primary Health, Inc. Boise ID (Primary Health Plan, Riverside Benefit Administrators

1996 - 2009 (TPA self-funded)

Accounts Receivable & Membership Services Supervisor - Technical documentation

writing of policies and procedures for Enrollment and user guides for all AMISYS subsystems. Managed enrollment

process (new business, renewals and maintenance enrollment) ensuring timely and accurate eligibility of members and

their dependents for health coverage through careful monitoring and check points and interpreting Federal HIPAA

Portability and State Mandates. Worked daily in self funded groups resolving claim and eligibility issues.

Managed multiple projects (benefit configuration, design and implementation of new products and invoices)

simultaneously. Produced weekly and monthly reports on membership.

Responsible for interpretation of group and individual contracts and served on committee for yearly rewrite of contract

language. Often assisted Compliance Manager in determination of language content. Explained contract language to

employers, insured and producers on an almost daily basis.

Responsible for HIPAA administration in the Enrollment process from 1996 to 2009.

Managed premium billing of 3 Million per month. Ensuring posting and reconciling accounts were completed in a

timely manner. Prepared yearly budget.

Provided superior Customer Service to members and providers with a goal of delighting the customer.

Managed Broker commissions, ensuring broker checks were issued on a timely basis and resolving any issues

regarding broker checks for eleven years.

Managed Ancillary Providers Davis Vision, Discovery (HRA), American Health Value (HSA), APS – Employee

Assistance Program, Willamette Dental, Delta Dental and Express Scripts Prescription processes from 1996 to 2009;

acting liaison troubleshooter between the Ancillary Provider and IT Department for Primary Health Plan.

Managed Benefit Analyst II – responsible for configuration of benefits, Enrollment auditor for renewal rates,

Broker/Producer regarding small and large group employer issues and commissions, produced AR & Enrollment

reports for self funded and fully insured groups, capitation, troubleshooter and Enrollment liaison with IT.

Responsible for investigation of fraud and Extension of Benefits claims. Also, responsible for managing COBRA

Administration of employer groups for Primary Health Plan and Riverside Benefit Administrators (TPA). Was

instrumental in implementing the new COBRA Subsidy benefit and administration of new COBRA regulations

effective Feb 09.

Assurant Health, Inc. Boise ID

Supervisor of Knowledge Management- Supervised ten Trainer/Auditor Specialists.

Training and Development included Team Building, creating user guides for system

7/2004 – 10/2004 enhancements on B.E.S.T., new hire training, cross training between all claims departments to

enhance employee productivity and accuracy. Introduced to Aubrey Daniels using a behavior-based performance

management system to transform employees’ work into something they are willing, ready and even eager to do by

positive reinforcement.

John Alden Life Insurance Company Boise ID

1984 - 1996

Regional Training Specialist- Job duties include performing ongoing needs assessments of the Group Health

Claims and Customer Service Departments; reporting and analyzing mainframe system problems through benefit

coding and testing. Designed and developed technical training for system enhancements. Developed and presented

internal training designed to enhance employee productivity and accuracy. Tailored training to fit identified problem

areas; phone and adjustments auditing; analyzed region trends for savings; supporting other JALIC regions as

needed, ensuring long range quality and productivity goals are achieved. Developed and taught ICD’9, CPT-4 and

Medical Language Training Courses.

Sr. Medical Claims Supervisor - supervised four departments (15 employees: Correspondence, Quality Assurance

(Medical Necessity), Provider Negotiations, Claims Adjustments and Accounting. Also processed Short Term

Disability and Life Insurance Claims. Counseled Nurse Case Managers in Group/Insured Eligibility and

contract interpretation. Assisted Provider Relations with most California and Washington provider networks. Some

credentialing experience. Worked with corporate attorneys on complaints and assisted in determining contract

language intent.

Claims Supervisor - Supervised 25 employees in Claims department (sixteen claims examiners and nine processors).

Responsible for Health, Vision, Long and Short Term Disability, Dental and Life claims for the state of

California.

Early Career

Medical Claims Approver- Approved group health claims on self funded ASO accounts for Boise Cascade, E G&G,

N.A.P.A. Auto Parts and J.R. Simplot. Communicated by telephone and letter with policyholder

representatives, hospital authorities and physicians. Interpreted group accident and health contracts, which

included a wide variety of coverage’s – Short Term Disability, Life and Medical claims. Reviewed medical operative

reports/history and discharge summaries submitted by physicians and hospitals.

Recruiting Specialist / Human Resources Generalist- Company manufactured hydraulic pumps and servo valves –

1500 employees. Responsible for all phases of professional and non-professional recruitment and placement.

Coordinated all phases of Human Resource functions, i.e., responsible for administration of division benefit plans

and also wage and salary administration (Hay System). Member of Safety Board for the division and monitored

workers compensation litigation cases. Was responsible for designing and implementing the salaried Performance

Review system and the hourly Performance Review system. Trained all senior management in EEO compliance.

Served on Board of Directors for Ventura County CETA program in California.

Education

Current area of study – Health Care Copywriting and Blog Website Design

Personnel Management, La Salle University, Chicago, IL

Train the Trainer Certificate, John Alden Life Insurance

CONTINUING EDUCATION: Attended numerous Management, Supervision, Time Management

(University of California-Santa Barbara), Interviewing, Worker’s Compensation and EEO Compliance Seminars -

Interviewing Techniques - Ventura CA

EEO Compliance - Ventura CA

Working in Teams - Boise ID

Business Grammar and Usage - Boise ID

Understanding Team Dynamics - Boise ID

Supervisory Management - Boise ID

Managing Change for Managers - Boise ID

Performance Management - Boise ID

Situational Leadership - Boise ID

Producing Results with Others - Boise ID

Workman’s Compensation Litigation - Los Angeles CA

HIAA Managed Care – Part A – Boise ID

LOMA FLMI – 01 – Boise ID

ICA – Medical and Dental – Boise ID

ICA-Customer Service-Boise ID

How to Use Teams to Improve Quality – Boise ID

RECOMMENDATIONS:

“Cindy is knowledgable in all things healthcare.” – Glenn Rogerson, Programmer/Analyst, Primary Health, Inc.

“Cindy is an exemplary leader. She is truly a Health Insurance Professional with a comprehensive

understanding of all aspects of the business. She is also not afraid to roll up her sleeves to get a job

done. You will never go wrong hiring Cindy and I was always grateful to have had her on my team”. –

Allan Einboden, Vice President, COO, CIO, Primary Health, Inc.

“Cindy was a very good person to work with at Primary Health, Inc. I found her knowledge and

experience very useful as I worked on I.T. programming with her”. – Fred Gremlich, Sr. Programmer Analyst,

Primary Health Inc.

“Cindy was an outstanding employee and a real positive influence within the company when she worked

for me”. – Jim Keller, VP of Operations, John Alden Life Insurance.

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