Customer Service Medical

Name: MOORE, WIL MA C

CAREER H IGHL IGHTS

Over 15 years’ experience in the health insurance industry for fully insured, self-funded,

H MO, Major Medical and IPA health plans. Specializing in Cost Containment and Claims

A djudication. Successfully managed Small Group Pharmacy Injectable Claims Review.

Partnered with internal and external constituents to improve processes which led to

significant cost savings. Overpayment Recovery Subject Matter Expert with superior

analytical and technical skills. Able to successfully handle the most complex assignments

and escalations while managing workload to meet all deadlines.

AETNA WORK EXPERIENCE

Title: Recovery/Savings Analyst (434023) Dates: 11/14/2011 - Present

Manager: ARNOLD, CAROL J Workplace Model: Home-Based

Key Accomplishments: Consistently exceeds Production and Quality Met rics. Have been

h ighly successful in identifying additional cost savings opportunities through detailed

analytical analysis of overpayment data. Highly Successful in handling internal and

external client escalations in a t imely manner. Resolve all issues to the satisfaction of the

constituent. Proactively identify and resolve gaps in overpayment policy and procedures.

Work well in cooperating with others for the benefit of the constituent and Aetna.

Continually maintain an optimistic and positive atti tude when faced with adverse

situations.

Title: Medical Claim Analyst (434033) Start Date: 01/30/2006

Key Accomplishments: Exceeded Production, Quality and Savings Goals for Small Group

Pharmacy Injectable Claims Review and also for COB Verification. Took personal

accountability for H MO Pharmacy Screening and achieved significant savings results which

exceeded several million dollars yearly. Set and pursued aggressive goals in order to reach

peak performance. Managed Service Delivery so that internal processes were invisible to

t he constituent.

T itle: Claim Benefits Specialist (430023) Start Date: 03/17/2003

Key Accomplishments: Exceeded Quality and Production metrics each and every month.

H andled complex escalations in a t imely and efficient manner. Proactively learned new

p rocesses and specialties while keeping current with t raining updates. Kept team informed

of updates to claims processing issues. Maintained a high level of professionalism as a

Superior Team Player.

EDUCATION

Currently attending Houston Community College since 08/2011

Degree: Trade School Graduate Major: Data Ent ry/ Word Processor School: Elkins Institute

G rad Date: 05/01/1988

FUNCTIONAL EXPERIENCES

Claims Claim processing - Medical or Hospital- H MO I n termediate - Performs in complex

situations

Claims Claims Administration - coordination of benefits (COB) verification I n termediate -

Performs in complex situations

Claims Overpayment recovery I n termediate - Performs in complex situations

Claims Policies & procedures I n termediate - Performs in complex situations

Customer Service Customer Service - Member Services - H MO products I n termediate -

Performs in complex situations

Leadership Lead significant enterprise-wide initiative I n termediate - Performs in complex

situations

Products-Medical H MO I n termediate - Performs in complex situations

Project Management Enterprise-wide project management I n termediate - Performs in

complex situations

TECHNOLOGY EXPERIENCES

Database M icrosoft Access I n termediate - Power user

Desktop Tools TE Microsoft Excel I n termediate - Power user

Desktop Tools M icrosoft PowerPoint I n termediate - Power user

Desktop Tools M icrosoft Word I n termediate - Power user

L ICENSES, CERTIFICATIONS AND PROFESSIONAL MEMBERSHIPS

VOLUNTEER EXPERIENCES

Working in nursery at church – Word of Restoration Fellowship.

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