Insurance Health

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

Atlanta GA 30303 443-***-****

Shelton Matthew Frazier

Objective

To acquire a position where I can use my skills and experience to contribute to the

overall success of the company while increasing my own abilities. I am a Dedicated

insurance professional with more than 10 years of experience providing customer

service, investigating and processing health insurance claims and performing life

and health insurance compliance duties. Excel in analyzing damages/causes,

interpreting policies and negotiating payment solutions. Effective manager of

multiple, high-priority projects and take pride in providing exemplary customer

service.

Experience Jun. 2012 – Jun. 2013 Quality Software Services, Inc. Columbia, MD

Medicare Advantage Prescription Drug Help Desk Business Analyst (Level Two)

Level Two Business Analyst for Quality Software Services, Inc. on a one year employment

contract. Quality Software Services, Inc. was awarded the CMS contract to operate and maintain

the Medicare Advantage Prescription Drug Help Desk on behalf of Medicare part D service

providers. The level two business analyst is responsible for troubleshooting, diagnosing and

resolving MA-PD Plans’ enrollment, premium and payment issues. Typical issues that are resolved

include, but not limited to the following: Enrollment file rejections, Premium payment option rejections,

SSA withhold inquiries, and Beneficiary entitlement questions/clarifications.

Average turnaround time from receipt to completion is 2 business days. Responsible for routing issues

that cannot be resolved directly to CMS for research and resolution. Issues are presented to the

Business Analyst for resolution via e-mail and warm transfer from level one Help Desk Analysts.

Currently processing more than 35 Help Desk Tickets and 30 Level Warn transfer ticket calls per week.

In addition, the Business Analyst is required to have a thorough knowledge of all

communications distributed by CMS to MA-PD plans, and to be able to explain the technical

aspects of system and changes and updated made by CMS to MA-PD Plans.

Advanced knowledge of the following systems: MARx, MBD, HPMS, Remedy and TSO.

Mar. 2009 – Sep 2011 Maryland Insurance Administration Baltimore, MD

Market Conduct Examiner

Market Conduct Examiner within the Compliance and Enforcement Unit of the Maryland

Insurance Administration whose primary duty consisted of the completion of both comprehensive

and target market conduct examinations of Life and Health insurance companies (foreign and

domestic) who conduct business within the state to Maryland to ensure compliance with

Maryland insurance laws and regulations.

Areas of examination included, but were not limited to: claims, billing, enrollment, provider

panels, adverse decisions, complaints and advertising/marketing.

Assessed fines and violations to carriers for non-compliance with Maryland Law.

Expert knowledge of Life and health insurance laws of the state of Maryland including but not

limited to COMAR, Michie's Annotated Code of Maryland and the Health-General insurance

Article.

Responsible for completed examination reports after the completion of examination. These

reports were reviewed by Senior examiners, Chief Examiners, and the Attorney General's office

for style, substance, and grammatical clarity. These reports are then posted for viewing by the

pubic after submission to the examined entity. Sample reports which can be found on the

Maryland Insurance Administration website (public information, market conduct examinations,

life and health) include Carefirst Bluechoice, Allianz, and Caremark PCS.

Received numerous verbal and written accommodations from management for quality and

quantity of work.

Became an examiner-in-charge (coordinating examiner responsible for the complete oversight of

an examination) after demonstrating the necessary skills and experience of a Market Conduct

Examiner.

Education 1995-1998 University Of Maryland Baltimore County Baltimore, MD

B.A., Political Science.

70 hours of undergraduate course work completed in the areas of law, economics

and accounting while attaining my Bachelor of Arts Degree in Political Science.

1989-1993 Gilman School Baltimore, MD

Extensive Knowledge of Medicare (including Parts A, B, C, D and Medicare

Supplemental Insurance), Tricare and Tricare Supplemental Insurance, Group Life

and Group Health Insurance, Whole Life and Term Life Insurance, Property and

Casualty Insurance, Annuities, as well as other insurance Products.

Fluent in the use of Microsoft Word, Excel, Access, PowerPoint, Lotus Notes,

Outlook, RMS, Flexx, FACETS, TSO, MARX, MBD, as well as other software

applications.

Extensive Knowledge of Medical Terminology including HCPCS level I and II codes,

ICD-9 codes and ICD0-10 codes.

HDI certified Support Center Analyst.

Licensed to sell Accident and Health Insurance in Maryland and Arkansas.

Certified to consult and sell both on-exchange and off-exchange insurance plans

through the Federal Health Insurance Exchange.

Contact this candidate