Health Insurance Professional

Traci Ervin

Cleveland, OH ( ************@*****.*** ( 216-***-****

SUMMARY

Diversified Professional with progressively responsible experience in

commercial and government lines of insurance. Experienced in medical

billing/collections, claims, customer service, and business operations.

Achieves high results in customer satisfaction, process improvement and

regulatory compliance. Enthusiastic team player, manages complex tasks and

meets critical deadlines. Highly developed interpersonal abilities,

facilitates atmosphere of collaboration and mutual support.

Professional Experience

UNITEDHEALTH CARE, CLEVELAND, OH

1996-2013

BUSINESS ANALYST, 2007-2013

. OBTAINED, ANALYZED BUSINESS AND SYSTEM FUNCTIONAL REQUIREMENTS FROM

OPERATIONS BY PRODUCT, BENEFITS, TO CREATE, PREPARED AND EXECUTE TEST

CASES FOR LARGE BUSINESS INITIATIVES.

. COLLABORATED WITH PROJECT MANAGERS AND SPONSORS TO DEFINE PROJECT

SCOPE AND VISION AND TO IDENTIFY CONSTRAINTS, DEPENDENCIES,

ASSUMPTIONS, RISKS AND ISSUES.

. Facilitated, conducted meetings and power point presentations for

Business and IT partners.

Team Lead - Audit and Compliance, 2005-2007

. Managed, coached and mentored staff of 9 auditors increasing quality

compliance performance results.

. Analyzed risks and developed solutions for clients' business

priorities and risk management needs, increasing customer satisfaction

and compliance.

. Collaborated with cross functional teams to developed and managed

strong working relationships.

Contract Auditor, 2003-2005

. Achieved consistent "excellent" ratings for compliance of audit

procedures and supporting documentation improving contract load

accuracy rate.

. Delivered excellent customer service using effective interpersonal

communications and consistent follow through building strong working

relationships with management, clients and external auditors.

. Identified deficiencies in contract loading, policy and procedures and

processing systems and initiated corrective action through root cause

analysis.

Customer Service Supervisor, 1999-2000

. Supervised, trained customer service staff, interviewed new hires,

served as subject matter expert for group benefits, claim related

projects and client service issues.

. Participated on corporate level task force including client

implementations for commercial sales accounts and offsite meetings.

. Delivered excellent customer service using effective interpersonal

communications and consistent follow through building strong working

relationships with management, clients and sales staff.

Other Relevant Experience

Senior Research Analyst

Market Systems Coordinator

Claims, Customer Service, Appeals Representative

Senior Collections Representative

Medical Billing and Registration Specialist

EDUCATION

MEDICAL SECRETARY, WORD PROCESSING, MTI BUSINESS SCHOOL

Professional development

Time Management

Workplace Ethics and Security

Diversity and Inclusion

Team Leadership

Facilitator Training

Total Quality Process

technical skills, Studies and programs

PROGRAMS/OPERATING SYSTEMS: MICROSOFT OFFICE (WORD, EXCEL, POWER POINT,

OUTLOOK), 10 KEY

ICD9, ICD10, CPT, HCPC Medical Billing and Coding Methodology, Medical

Terminology

Medical Billing and Claim Processing Systems: TOPS, COSMOS, DIAMOND,

FACETS, IDX and EL-COMP

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