Quality Assurance Customer Service

Enrollment, Quality Assurance, Data

Trevison Sedeno Entry

● Responsible for new and existing,

group and individual member

*** ******** ****** • Brooklyn NY 11225

information as needed, in required

347-***-**** • ********@*******.***

systems

● Quality Assurance, both

manually and electronically for new

Objective: To elevate and procure a professional position

benefit ID card outlay project.

where my expertise may be utilized and expounded upon

with prospective advancement. ● Handled data input of new and

existing third party lawsuit claimants

Summary of Qualifications: ensuring accuracy of entered data.

Nine years of insurance expertise at a Fortune 500 ● Establish correct review of

company, where communication and analytical skills are instructional data and performed

mandated. Award winning customer and organizational comparable review of information,

skills based in a fast paced, production environment. detecting errors and ensuring

Comprehensive knowledge of company based computer proficiency. .

programs including MHS, IPDW, INFO, BBCD and ● Verified and validated scanned

Microsoft Office Suite. information and document control

number for accuracy, in electronic

Experience: data base.

2006-Present Independence Blue Cross*1901 Market

Street*Philadelphia, PA Uniprise, United Health Care

Albany NY

Eligibility Verification Specialist, PDP Customer Service/Claim Processor

Reconciliation Specialist ● maintained a comprehensive

● Exclusive review and comparative knowledge of the claims processing and support

monthly analysis of data and reports systems.

from the Centers for Medicare and ● Responsible for effective, accurate

Medicaid Services (CMS). and timely review of COBRA,

●Responsible to research and resolve Medicare and International claims.

inconsistency among CMS, MHS, MSIQ ● Investigated telecommunication

and INFOCARE files, and correct data from clients concerning medical

in internal systems, when necessary. claims in process as necessary.

● Investigate CMS and internal ● Knowledge of ICD9 and CPT

coding regarding adjudication of

reports to establish suitable

claims in a timely manner.

resolutions required to eliminate

continuing inconsistencies.

Education:

●Primary specialist in charge of Pre

2010-Presemt Ashford University

Enrollment Data review and training. Clinton, IA (Online)

1997-1998 Hudson Valley Community College

Benefit Coding Specialist

Troy, NY

● Maintains MHS system daily to assure

vital information is correct for claims

payment process and insurance card

distribution.

● Key all information pertaining to new

plans and member coverage accurately.

● Assess and complete benefit work

orders in MHS as assigned.

● Create and update new plan work

orders into new plan design system

accurately, corporation wide.

2002.2006 Various Staffing Agencies

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