Ray Cook

Email: abqdiq@r.postjobfree.com

Address: **** ****** **** **

City: High Point

State: NC

Zip: 27265

Country: USA

Phone: 336-***-****

Skill Level: Experienced

Salary Range: $41,000

Willing to Relocate

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

RAY COOK

Experience Pre-Pay Quality Analyst

Aetna 2006-Present

Responsibilities include reviewing claims paying out more than a set pay

amount by claim processors to determine the claim is paying according

to the provider contract specifications, plan sponsor plan of benefits,

individual plan of benefits and company policy and procedures. If the

claim was correct it was returned to the processor to be adjudicated. If

not correct the claim was returned to the processor with an explanation

of what was incorrect and how to correct it based on provider contract,

plan of benefits and related policy and procedure information. Also

required to attend regular training sessions on changes to policy and

procedure and to complete weekly training courses for the same reason.

Required to meet quality and production standards.

Medical Claim Management Quality Analyst

Aetna 2003-2005

Responsibilities included reviewing claims handled by medical claim

management analysts for accuracy and that the instructions they were

providing to claim processors were according to provider contracts and

specifications, plan sponsor and individual plan benefits and company

policy and procedure. If correct the information was entered on a spread

sheet. If incorrect the review was returned to the analyst with an

explanation of why the review was incorrect providing details from the

provider contract, plan sponsor and individual plan of benefits and

related policy and procedure information. Also required to attend

training sessions on changes to policy and procedure and to complete

weekly training updates. Also sat on a committee to review and revise

policy and procedure requirements. Required to meet quality and

production standards.

Continuous Quality Improvement Quality Analyst

Aetna 2000-2003

Responsibilities included working with claim processors on their

individual quality. Answered questions on claims and provided feed

back, coaching and training needed. Reviewed weekly training updates

and forwarded applicable updates to processing staff. Reviewed errors

with processors according to provider contracts, plan sponsor and

individual plan specifics as well as company policy and procedure.

Required to submit monthly reports on activities.

3802 Eagles View Court High Point, NC 27265

336-***-**** Home;336-***-**** Cell

RAY COOK

Claims Processor

Aetna 1984-2000

Responsibilities included processing medical, dental and vision claims

according to provider contracts, plan sponsor and individual plan

specifics as well as company policy and procedures. Also handled

transplant claims. Responsible for attending training sessions and for

maintaining quality and production standards.

Community and Volunteer Involvement

Board of Directors Homeowners Association 2005-present

Board Member 2005;Vice President 2006;President 2007-present.

Duties include attending meetings, schedule and conduct meetings, work

with property management company in response to questions, concerns

and complaints received. Respond according to community by-laws and

restrictive covenants.

Siamese Cat Rescue Center 2005-present

Meezer Express Driver-transport cats who have been rescued and

on the way to the adopters. Attend cat shows and work in the retail booth

selling merchandise to raise funds for the rescue.

Education Cornerstone University

Grand Rapids Michigan-BA Speech/English, May 1982

References Available upon request

3802 Eagles View Court High Point, NC 27265

336-***-**** Home;336-***-**** Cell

RAY COOK

References Ms. Billie C. Shuler, Business Project Program Manager, Aetna

336-***-****

Ms. Melanie A. Miller, Consultant, Law Reg Audit and Reporting,

Aetna. 570-***-****

Ms. Kate Albright, Trainer, Aetna Service Operations, Learning and

Performance, Aetna. 336-***-****

Ms. Juliaette Thomas, Curriculum Facilitator, The Early Middle

College at GTCC Greensboro. 336-***-****

3802 Eagles View Court High Point, NC 27265

336-***-**** Home;336-***-**** Cell

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