Claims with Customer Relations

Home: 267-***-**** **** N. Marlow St

Mess: 267-***-**** Philadelphia PA 19124

Email Address: ******.**.**@*****.*** FT

YVETTE D CALDWELL

Profile

Establish a position as a Senior Team Player with outstanding customer relations skills, which can successfully manage tough customer needs. Detailed oriented, accurate, analytical and efficient recognized as an effective deft problem solver.

Professional Experience

IGATE/ Capegemini

LTC Business Claims Analyst

November 2015 to Present

This is a TPA for CNA which holds policies for Long Term Care Employee Groups

Process and analysis Invoice for Home Health Care claims & Adult Day Care and Facility & Nursing Homes.

Technical portion is assisting new employees with training and questions pertaining to the claims we receive.

Efficient processing of these claims to stay within our Service Level Agreement SLA, assist the Team Leads with technical issues with problems that need to be address in a timely fashion.

Make adjustments to claims also send requirements to the CNA team requesting for certain information to be update in order to process a claim. Policy verification some calls need to be made to assist a policy holder, or a call needs to go out to verify information in order to complete a claim.

IGATE/Capgemini

LTC Claims Support Analyst

July 2015 to November 2015

This department receive request from CNA to send documentation to Providers, Policy Holders, Medicare, Medicaid. Request received from claims analyst to send out AOB paperwork, request W-9 from providers, and add providers into database for claims analyst to be able to process claims accordingly. EOB request from Medicare and Medicaid and certain situations make a phone inquiry.

Register all invoices received in system so they can be routed to the claims analyst to process within the SLA. Expected amount to register in system is about 100 or more no less, unless you are on a special project per management request.

AIG Educational Markets

Business Claims Analyst

January 2008 to October 2014

Maksin Management sold to AIG

Processing Accident & Injury Medical Dental Property and Casualty claims for various Colleges and University, Self-Funded Accounts

Refund & Claims Adjustments requesting proper documentation that is requested by the insurance, for other insurance information, or medical records request, & HIPAA certificates

Processing all documents that come in for the insured that has been requested

Help customer services department on numerous of occasions to clean up call value in queue

Process around 85 to 125 claims a day, other special projects for management that allow clean claims to go to proper department for processing.

Reprice claims for various group AIG brought

Previous positions held:

Express Scripts Patient Care Advocate for 2003-2005

Target Corporation Human Resources Clerical 2003-2004

Independence Blue Cross 1994- 2000

Senior Claims Examiner, Adjuster

Senior Dedicated Customer Relations Claims Representative

Keystone 65 Customer Service Relations Representative

Administrative Assistance to Sales Representatives

Keystone First Telemarketer

Education

Pierce College 9/79-2/81

Penna Licensed Insurance Producer

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