Customer Service High School
Resume:
Vivian De Lawrence
Hartford, Connecticut 06120
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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