Yvonne Mia

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

St Augustine FL **080

904-***-****

OBJECTIVE:

To use my skills and knowledge to challenge me in a rewarding position while increasing my responsibility to be a value to the company.

EXPERIENCE:

Blue Cross Blue Shield of Florida, Small Group Enrollment Coordinator

April 2007 to Present

Coordinate and/or communicate with external agents, agent coordinators or area managers to obtain information. Coordinate with appropriate internal areas (e.g. CPIM, Medical Underwriting) to resolve issues or validate compliance. Perform follow-up activities with agents and other internal areas in a timely manner. Render a decision and communicate decision in writing or other media, as appropriate, to agent and group. Prepare documentation for group setup for use by other internal areas. Record group enrollment details into the Siebel system per instructions and requirements. Worked Small Group Enrollment Projects i.e. GSR Validation and Cobra Clean up. Working knowledge of BlueChoice, BlueCare, BlueOptions, RX, Life HRA/FSA, ASO and fully insured. Experience in RBMS, MHS, Word, Excel, MyBlueService and Siebel.

Blue Cross Blue Shield of Florida, Personal Service Representative

September 1999 to April 2007

Establish and maintain member enrollment. Ensure compliance with internal, state and federal polices and laws.

Responsible for invoicing and reconciling premium income, minimizing financial risk to ensure departmental and corporate goals.

Responsible for auditing of all Personal Service Representatives in a timely manner.

Work closely with Group Administrators regarding enrollment and billing.

Use company payment status using company records. Accounting experience for 8 years

Experience working with RBMS, Siebel and Prime. Working knowledge of BCBSF product lines. Knowledge of Small Group Reform Legislation, Cobra, Florida Health Insurance Coverage Continuation Act.

Blue Cross Blue Shield of Florida, Customer Service Representative

September 1998 to September 1999

Experience researching all processing systems.

Adjudicated claims and inquires within contract benefits and claims processing guidelines.

Extensive knowledge of provider files and medical terminology, CPT-4 and ICD-9 coding and pricing and reimbursement.

Educated customers regarding benefits and services in a responsible accurate and professional manner on all systems.

EDUCATION:

Bruton High School, High School

Graduated, June 1983

LANGUAGE SKILLS:

English

REFERENCES:

Available upon request.

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