Kelly V. Lewis

*** ******* *****, *** ** * San Antonio TX 78213 * 210-***-*****ad2k5w@r.postjobfree.com

Ethical Leadership Management Skills Results-Oriented

Objective

To obtain a position with the opportunity for upward mobility with a growing and stable organization.

Professional Profile

More than 10 years of experience as a highly diverse professional offering expertise in management (multiple locations), recruiting, coaching, and operational efficiency. Educated professional with a proven ability to lead projects and accomplish desired outcomes. Able to multi-task, excellent people-person and a skilled communicator. Computer/office skills in MS Windows, Word, Excel, 10-key, Data Entry, Client Relationship Management software.

Education

BS, Biology, Georgia Southern University

Employment History

Claims Examiner, WebTPA: 2021-Currently

Duties include: Thoroughly reviewing, analyzing, and researching complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process for payment. Navigating across various computer systems to locate critical information. Knowing CPT and ICD-9 coding to ensure accuracy and timely processing of the member's claim. Assisting with escalated claims to resolve complex issues for team members and internal customers. Supporting implementation of updates to the current procedures and assisting with new system training/mentoring. Reviewing guidelines as well as benefit plan documents and certificates to ensure proper benefits appropriately applied to each claim. Analyzing and identifying trends and providing reports as necessary.

Senior Claims Examiner, WellMed: 2020-2021

Duties included: Research, processing and adjudication of claims. Thoroughly reviewed insurance policies to verify medical necessity and coverage. Facilitated claims investigation, negotiated settlements, interpreted medical records and authorized payment to subscribers and providers. Other responsibilities included resolving claims appeals, researching benefits and verifying correct plan loading.

Customer Service Representative, Aetna Medicare Service Operations: 2018 – 2020

Duties included: Answering questions and resolving issues based on phone calls and correspondence from members, providers and agents. Guiding members through plan benefits and Aetna policy and procedures while complying with Medicare guidelines. Demonstrating behaviors to connect, engage and champion for the best health outcomes for members. Using Rumba to read claims and being aware of medical terminology, diagnosis and CPT codes in order to send claims for correction.

Executive Assistant/Personal Assistant, Dinah Lovett, LLC (Former Presidential Chief of Staff): 2013 –2018

Duties included: Making decisions and delegating work to staff, influencer in decision making processes, screening phone calls, inquiries and requests, arranging travel, visas, accommodations and meeting and greeting visitors at all levels of seniority.

Consultant, The Kenaly Complement: 2012 –2013

Duties included: Providing leadership and serving on the enrollment management team, improving quality of student services, budget management, improving customer satisfaction by nearly 60% and ensuring compliance.

Default Prevention Manager, Life University: 2011 –2012

Duties included: Facilitating student financial counseling, implementing the inaugural default prevention plan for the university and assisting students with rehabilitation on defaulted loans.

Campus Director, American Professional Institute: 2010 –2011

Duties included: Providing campus leadership for multiple service units, training and cross-training staff to ensure optimal student success, implementing a student retention program, and monitoring compliance.

Senior Client Relations Manager, EDFUND: 2005 –2010

Duties included: Managing student loan volume for SE United States, increasing sales by 50%, client relationship management and developing/implementing financial literacy and default prevention program.

Consultant/Account Executive, Georgia Student Finance Commission: 1999 –2005

Duties included: Building relationships with higher education professionals, increasing sales by 100%, facilitating college financial workshops and training administrators on federal and state guidelines.

Student Financial Aid Counselor, Various Georgia Universities: 1994 -1999

Duties included: Counseling students through financial aid process, coordinating Federal Workstudy Program, campus outreach activities and facilitating college preparation workshops.

References

Furnished upon request.