Health Insurasnce Claims Trainer / Analyst / Project Manager

LEE KAROL

**** **** **** ****** *** Angeles, CA, 90034

H. 310-***-**** • C. 310-***-**** email: julee7@ pacbell.net

CLAIMS TRAINER

Dynamic, engaging educator and analyst with an expertise in project management and training coupled with supervisorial experience:

Training staff at all levels from entry to executive in small, mid-size and large instructor-led and remote group settings;

Utilizing all Microsoft applications (Word, PowerPoint, Excel, etc.); creating animated PowerPoint training presentations and polished instructional manuals as well as other graphic deliverables;

Thorough comprehension of claims adjudication methodologies, policies, procedures and laws (including up-coming ICD-10 codes); proficient in three claims adjudication systems (MC400, IDX, ika-Sytems) as well as office equipment (SmartBoards, printers, etc.);

Proficient in quick yet efficient, easy to understand staff memos and guides on processing and/ or policy change as well as effective training materials that are long term utilized and valued;

Use of multiple training modalities to promote retention strategies;

PROFESSIONAL EXPERIENCE

SCAN HEALTH PLAN, Long Beach, CA • 3/2011 to 7/2015

Claims Training Specialist3

Established and singularly managed the organization’s education department including:

Creating and delivering all classroom led instruction on policy, procedure, system changes/enhancements and processing improvements both in person and via remote training sessions (Northern California / Arizona);

Constructing all tests and training evaluative tools;

Converting raw data, figures and flow-charts into refined instructional training materials, manuals participant guides and memo alerts for staffs in both office locations;

Expanded a one day, claims customer service, new hire program (including system navigation) into a comprehensive three-day entry level training session; created an accompanying manual and PowerPoint still being used;

Helped introduce and train the entire department on a company-wide new software switch.

Created a number of hands-on training session - utilizing laptops - for up to 170 staff members

Authored a formal claims adjudication training manual addressing all aspects of training presentation assemblage gleamed from historical company documents and cultivated expertise.

Consistently attain high evaluative ratings from training participants and ongoing acknowledgments regarding the useful applicability of training materials on an ongoing, on-the-job basis

HEALTH CARE PARTNERS, Los Angeles, CA • 5/2004 – 3/2011

Claims Training Specialist

Recruited to create an education program from the ground up in addition to training sessions on critical matters

Reported to multiple supervisors effectively accommodating different management styles and priorities;

Converted thick, wordy documents into a comprehensive training manual that addressed everything from technical system enhancement to HIPPA to fraud, waste and abuse policies…to name a few;

Created job aids, staff memos and training guides /manuals that effectively instructed and informed department personnel of system changes and additions;

Managed all facets of topical training sessions from scheduling training rooms/times to facilitating training sessions with individual units and up to all 180 departmental employees;

Expert in attention retention …I don’t lose anybody in training!

Developed refresher training programs including annual sessions on CMS required training;

Co-designed and solely maintained the department’s on-line training reference library;

Consistently attained merit raises and high ratings by training participants and management

CANTER AND ASSOCIATES, Los Angeles, CA • 2001-2003

Team Supervisor – Distance Student Enrollment Department

Supervised daily operations (and a staff of five) for an on-line Master’s program for teachers; working collaboratively with university counterparts to resolve complicated student admissions and continuance requirements:

Fielded student registration calls and maintained admission logs for four out-of-state universities.

Worked with recruiters to pre-group students into study groups and promote additional organizational products

Conducted quarterly/annual staff evaluations, refresher training sessions and engaged in personnel conflict resolutions;

Smooth well-working relationships with the different personalities of my university counter-parts

TRANSAMERIC OCCIDENTAL LIFE, Los Angeles, CA • 1998-2000

Medicare Education and Training Specialist

Conducted a variety of workshops and seminars, throughout Southern California, introducing providers to new and annual Medicare program changes; co-designed and co-facilitated sessions of up to 450 participants:

Liaised to specialists (Podiatry, Osteopathlogy and Care Plan Oversight), providing all Medicare-related training materials and answering coverage / benefit queries for those three specialties

Researched and created a thorough and detailed Y2K training presentation and booklet that was recognized by the federal government (CMS) and a complementary training manual that was so well received it was implemented for National Heritage Insurance Company

Involved in project management for implementing large, multi-city seminars and workshops.

Worked closely with the Provider Relations Department and the Fraud department to successfully resolve provider as well as fraud, waste and abuse issues.

Elaborate visuals (like a millennium clock that counted backwards to midnight December 31st - part of Y2K training) and activities that keep attendees engaged

EDUCATION / CERTIFICATES / MEMBERSHIPS

Associate of Arts Degree, Los Angeles Valley College, Valley Glen, CA

HIAA Fundamentals Of Health Insurance – Part A Certificate of Completion

Bureau For Private Post-Secondary/Vocational Education License (medical billing/medical claims examining instructor’s certificate)

Member of ASTD–L.A. Chapter

4 year member of ToastMasters Deluxe (District 1)

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