Vivian De Lawrence

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

Hartford, Connecticut 06120

860-***-****

Summary: I am a reliable and dedicated leader with over twenty-five years

of

experience. I am able to achieve high levels of productivity in a fast pace

environment while maintaining quality and accuracy. I have proven skills in

customer service, written and verbal communications. Although, I can work

independently, my ability to communicate and work well with others has been

a positive impact to the departments I have worked in. I view each new task

as a challenge and multiplicity has been a driving force in my

accomplishments.

Experience:

2007 to 10/28/2012

Aetna Workers Comp Access

Network Analyst

Responsible for establishing a new file system for the State of New York

Recommendation of Care and Certified Files.

(12 month time frame for file completion and audit)

-This file project consists of 26,000 files. I trained and managed a

group of

20 individuals to ensure a timely completion of one year.

-Utilized multiple data bases to locate and research documentations to

insure

that each file was in compliance with New York Rules and Regulations

I.e. Signed Contract, Amendment, Addendum, Medical Approval from the

State of New York, Worker's Comp Authorization Form, and the Medical

Code for the provider's specialty

These audits are conducted per request of New York State and or the Aetna.

Usually certain counties are tagged within the state to ensure state

compliance within a particular area of the state. Audits are conducted for

all new provider files. I am responsible to respond to all requests and

to resolve any issues with a New York Provider, via letter or conversing

with the provider or the Aetna New York/Hartford Management staff or refer

to our Legal Department.

..Maintained the Universe Excel Spread Sheet which contains all of the New

York

providers displaying their status and activities

..Prepare monthly reports on productivity increase or decrease

2005 - 2007 AETNA

Group Insurance Underwriting,

Underwriter Assistant:

- Receive all the Attending Physicians Reports

and document system based upon comphrehension

of correspondence

- Receive all Evidence of Insurability Reports

Examine the request for qualification for

coverage and input information into system

- Establish a microfilm number for completed cases

- Give assistance to the Underwriters where-

ever required

1994 - 2004 AETNA

Overpayment Unit,

Analyst:

- Managed daily inventory of incoming checks to the Overpayment unit

- Delegated checks to the other Analysts in priority order to ensure

maximum productivity

- Prepared monthly financial reports for Senior Management,

indicating all our receivables for solicited and returned checks

- Researched in-house/field office inquiries regarding check status

- Input checks information into the COPS System

- Balanced credit transmittals to assure balance agreed with the

check balance for banking purposes

- Developed account reports daily for the incoming checks

- Request replacement checks for stale dates, stop pays, insufficient

funds and etc.

- Researched and analyzed outstanding accounts for the Accent

Collection Department

- Processed Manage Care credit transmittals for overpayments

- Processed re-adjustments for HMO overpayments (applied the

applicable payment via the COPS System

1977 - 1993 the Travelers Companies, Hartford, CT

Product Pricing,

Analysts:

- Updated and maintained prescription card data base

- Submitted written rate filings to State Departments of Insurance

for approval

- Developed Lotus spreadsheets to calculate Managed Care Groups

- Conducted quarterly Surveys to gather information from (50) fifty

claim offices regarding changing hospital room rates

- Input rate information into APL program to produce reports.

- Help to underwrite and price PPO areas.

- Developed lotus spreadsheets to study hospital pricing trends

(for the developing of new products)

- Extracted news and periodicals from Corporate Text Management

(data base of general information & updates, etc.)

Education: Hartford Public High School

Excel

Microsoft Word

COPS (Centralized Overpayment Processing System)

Typist (80/wpm)

Pension Certification

Customer Service

New York Research & Review (ERISA Rules and Regulations)

Letter writing (Travelers in-house training)

Technical Training: Lotus 123

Hobbies: Piano/Organ

Music of all kind

Arts & Grafts

Photography

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