Medical and Health Benefit Administration
Resume:
Paula Lynn Holthaus
**** **** ***, *********, ** 21206
************@*****.***
EXPERIENCE
****-**** ********** *********, **
Director of Claims and Customer Service 2007-2014
•Managed migration of the Baltimore Office to the new Integrated Client Environment (ICE) with PowerStepp
•Supervised Operations Department including claims, customer service and eligibility
•Formulated practices for claim processing
•Created Best Practices with other CoreSource Offices for each of the current procedures to move to ICE
•Established working relationships with Clients and promptly resolved customer service issues as well as claim issues
•Collaborated with Vice President of Operations, Client Managers, Human Resources, and Sales
•Developed uniform practices with other Offices to create consistent practices for the system
•Collaborated with Trustmark Legal Department and Trustmark Refund Recovery on legal issues
•Independently ensured prompt reinsurance payments for all Clients in the Baltimore Office
•Collaborated with Reinsurance Co-Ordinator and Vice President of Reinsurance to ensure deadlines were met
•Researched and released all claim payments over $50,000 within the Baltimore Claim Department
•Handled all personnel issues within the Operations Department including Performance Improvement and creation of mid-point and yearly
Evaluations
Medical Claim Supervisor 1995-2007
•Supervised up to 13 Medical Claim Analysts and Customer Service Analysts
•Managed backlog and turn around time to company expectations
•Addressed Client issues as well as telephone issues
•Collaborated with Client Managers, Directors, and other Supervisors
•Developed Client relationships for groups within the Unit and Office
•Collaborated with Trustmark Subrogation Services
•Maintained Reinsurance guidelines and handled large claims over $20,000 within Unit
•Handled all personnel duties within the Unit, including timecards, vacation scheduling, and flex scheduling
•Handled all personnel issues within the Unit, including Performance Improvement Plans as well as yearly Evaluations
Claim Training Co-Ordinator 1994-1995
•Conducted 12 week medical claim training Classes from 2-6 Trainees
•Trained on processing responsibilities as well as Customer Service functions
•Reviewed all work by Trainees with a 100% work audit until their release from Training
Medical Claim Analyst 1990-1993
•Assigned to various employer groups
•Worked with the Client, Supervisor, and Client Manager for on-site meetings,etc.
AWARDS AND ACHIEVEMENTS
Outstanding Leader Award, HIPAA Certification, Yearly
Employee of the Month, 2008
Outstanding Leadership Award, 2007
Crusader Award, 2006
Quality Assurance Award, 1990
EDUCATION
Medix School Towson, Maryland
•Medical Office Administration
•Medical Terminology
The Catholic High School of Baltimore Baltimore, Maryland
•High School Diploma
VOLUNTEER WORK
•CoreSource Wellness Committee, 2011-2013
•Crohn’s and Colitis Foundation of America, Maryland Chapter 2011-Present
•BARCS Animal Shelter, 2004-Present
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