Customer Service Insurance

EXECUTIVE SUMMARY

Cherae D. Barrett

**** *. ***** ****

Olympia Fields, IL 60461

Cell: 312-***-****

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

EDUCATION:

General/Business Courses

Joliet Central High School - Joliet, IL

H.S. Diploma

Undergraduate certified classes:

Word Processing, & Business Administration

Joliet Junior College - Joliet, IL

Academy for Advanced Learning

Insurance Pre-License Education

Schaumburg, IL

Licensed: Accident/Health & Life

SUMMARY of PERTINENT SKILLS:

I am a highly skilled and trained professional with majority of 15+ years

in Healthcare Claims experience, and 3 years in preferred healthcare

services. Technical office skills include:

Office Works, DOS, Word Perfect 5/6, All Microsoft Office products

operating system/software thru Windows XP, Windows NT & 2000, Word, Excel,

Access, Power Point, Outlook, Lotus Notes, Crystal (reports) 2008

Auditing systems & software used:

Infinity, NICE, Witness & E-Witness, Liberty, Call Care Browser, UCAT, E-

Monitoring, Q-finiti

Mainframes used:

IBM Mainframe, RUS, STAR, WGS 2.0, AS400, ISSI, Familiar with (LSI, CCI,

EDT, LGS),

Windows based: MaG - Matis Global, SIA

Pertinent industry skills:

ICD-9/10 & CPT Codes, DRG, Knowledge of NAIC/NBA/SBA regulations, HIPAA

laws, Sarbanes & Oxley, 15+ years medical insurance (5 years dental) claim

payer, Proficient with healthcare claim adjudication standards & policy

procedures, with strong analytical and investigative skills, Illinois State

Licensed Agent holding: Accident/Health & Life Insurance. Hold proprietary

trading knowledge of futures, stock & options with knowledge of various

broker strategies.

Cherae D. Barrett

Page 2 - Cont.

SELECTED PROFESSIONAL EXPERIENCE:

Addus HealthCare - Healthcare Field Rep.

Homewood, IL December 2011-Present

Provide aide and assistance as home healthcare representative for plan of

care to include assistance to disabled individuals with bathing, dressing,

grooming. Provide assistance with transferring clients, if need be

assistance with continence, telephoning, preparation of meals. Client

assistance included laundry duties, light housework, providing shopping

assistance and errands, provide supervision and oversight of medications.

Additional assistance involved providing nursing healthcare, monitored

appropriateness of care, the setting, and progress of discharge plans. The

ongoing review was directed at elevating the quality of care in the home

setting while keeping costs low as possible during medical claim, DME and

policyholder review. Healthcare services provided included wound-care with

enzymatic debridement, negative pressure wound therapy, gastric tube

feeding, administered antibiotics through PICC line IV.

AXA-Assistance - Medical Claim Auditor

Chicago, IL

June-2007 - Sept 2010

As of November 2009 I worked under contract. Hired as Auditor for medical

claim payment in hold status utilizing Claim Audit tool(s) according to

established processing & audit procedures. Duties include audit high

dollar claims according to established processing and audit requirements.

Audit PPO & TPA accounts for accuracy as needed. Auditor of company's

(BCBS) Blue World Wide Expate plan. Provide detailed reporting of audit

findings to Quality Control while the role must serve as a reporter of

fact(s). Identify trends in audit errors and training opportunities and

reports to assigned respective Managers. Prepare Examiner appeals for

committee review, including additional Auditor(s) opinion, as needed.

Participate in audit calibration session(s). Providing feedback to staff

on audit related issues. Work as a catalyst, an interface between

different groups. Wrote & completed Quality Control Claim Audit Policy,

and implemented improved evaluation forms, new rebuttal process,

responsible for communicating and informing documented system issues,

error trends, researched translation for foreign medical claims. Provide

consultation on needed preparation for compliance regulations for external

audit thru Performance Planning and Project Managing. Meet regularly with

Sr. Management to update and inform staff of implementing corporate

standards to apply internally. Identified and found claim training tool

resource for the company. Introduced the on line claim training tool for

the Training Department.

United Insurance Group - Licensed Agent Rep.

Burr Ridge, IL September

2006 - Jan 07

Senior Specialty markets offering Medicare Advantage, Medicare Prescription

Drug Plans, Med Supplements, Long Term Care, Annuities, and Life products.

Certified Medicare Advantage plans training received from Humana Insurance

of Oakbrook, Illinois.

Cherae D. Barrett Page 3 -

Cont.

A Wellpoint Company

Unicare Insurance - Auditor II Bolingbrook, IL

April 2000 - Aug 2005

Hired in April 2000 to process claims for second shift as a Claims Examiner

III. Processed an approximate 900 claims per week. Also trained on keying

claims from UB-92s and HICFAs into RUSS Mainframe for overtime hours; also

worked on Appeals for Claim Denials and Additional Benefits. As of July

2000 second shift was eliminated in order to assist the Customer Service

unit during the first shift. Daily projects were: to coordinate and adjust

claims for the state of Texas from our Provider Relations units in Plano

and Houston, Texas, answer and resolve Management and Supervisor calls and

complaints, train newly hired Claims Associates, and answer and assist

customer service on issues of reconsideration of claims, etc.

Promoted in Feb/2001 to Quality Auditor II. Responsibilities include:

auditing customer service calls for technical accuracy and soft skills

quality, and auditing of claims for accuracy. Provide on-going and

meaningful feedback to operational units. Make recommendations and

identify specific training needs. Develop relationships with respective

associate, supervisor, manager, or supporting area. Discuss results with

representative and/or supervisor/manager.

Customers serviced: Individual & Small Group Client Services for benefits

and claims, Small Group Underwriting, Small Group Membership. Review live

and recorded phone and input of data in system for accuracy. Compare EOC /

Benefit Agreements with the benefits displayed on line for accuracy.

Audited Individual & Small Group inquiries. Provides MBU with error

analysis, recommends improvements to prevent errors, presents quality

improvement / best practices to MBU unit and Quality Circle meetings.

Ensures incoming calls are compliant with HIPAA laws and regulations.

Make recommendations for additional training needs. Documented errors,

analyzed trends and prepared reports to management using Excel and Word.

Prepare other related activities as required. Auditing customer service

calls for technical accuracy and soft skills quality, and auditing of

claims for accuracy. Make recommendations and identify specific training

needs. Develop relationship with respective managers, supervisor,

associate and other support areas. Discuss results with representative and

supervisors. I was last responsible for integration and implementation

within the Bolingbrook office of new guidelines to mirror offices across

country, also responsible for prepping spreadsheets and databases for

corporate goal Operation Performance Metrics. Assist auditing external

vendor through monitoring of live and prerecorded using Witness/equality

Balance R6.

EYE II EYE, Inc. - Account Executive

South Holland, IL January 1999-April

2002

Provided advanced consulting services with the following responsibilities:

manage all personnel/consultant records, promote outside sales to potential

vendors or clients, provide public advertising and marketing, create

company brochures and letterhead, and develop projects.

I assisted with the purchase of corporate literature and products.

Provided Project Management over various deals and contracts and made

several contacts by making appointments with future clients. While

marketing with clients and vendors, negotiated for IT consultant rates, as

well as,

the percentage of our agency fee for placement of service. Determined some

facts of the actual agreed contract then create and re-wrote legal

contracts. Provide contract recruiting for technical personnel into job

placements outside the company.

Cherae D. Barrett

Page 4 - Cont.

Empress Casino - Credit Executive/Executive Host Joliet, IL

& Hammond, IN

February 1993 - December 1998

From 1993 to 1998, I began in Joliet as a Credit Operator. I was promoted

to Concierge Club Supervisor, to Casino Host, and then into a Credit

Executive/Executive Host position. I encompassed a great deal of

responsibilities with the later position at the Majestic Star Casino in

Gary, Indiana. My duties included: generating a minimum of $100,000.00 in

revenue, approving and establishing lines of credit in access of $10,000.00

for new and existing customers, reviewing credit files, closing defaulted

credit lines, making collection calls and interacting with other internal

departments. I provided services to the Marketing Department as an

Executive Host planning and developing new strategies and advertisements to

retain a certain level of Casino player as a satisfied customer. I

provided means of entertainment by way of invite to elaborately planned

parties, pro-basketball games, dinners, shows, and usually provided

limousine transportation to and from events. Normally hosting the event or

gala, I would personally take customers to many events. Prior to this

position I supervised and co-managed 49 Concierge Club Representatives,

providing training, auditing, and evaluations. As a Credit Operator I

learned all credit procedures and terminology for the processing of credit

applications, as well as how-to deal with customers face-to-face and on a

one-on-one basis; later preparing me for credit approval.

Travelers Insurance - Benefits Specialist Naperville & Matteson, IL

1988-1993

Career began with Travelers Insurance in 1988 as an Auto Insurance Policy

Rater. There I balanced and calculated figures for homeowner and auto

insurance premiums. Later in 1990, I worked with Mass Mutual Insurance of

Matteson, Illinois as a Medical Claims Adjustor reviewing and paying

approximately 400 medical claims a week; communicating directly with over

500 insurers per month in the accurate and timely resolution of their

billing problems. I worked with Mass Mutual for one year, then returned to

Travelers Insurance when offered the position of Claims Examiner, of later

promoting to the position of Benefits Specialist for the Coordination of

Benefits area investigating fraudulent claims. Worked with Travelers

Insurance for a total of (5) five years. My duties included many of the

same as a Medical Claims Adjustor concentrating on Managed Care & PPO

Products.

Contact this candidate