Mary K. Humel

*** ****** ******

Ludlow, MA *****

413-***-****

WORK EXPERIENCE

Senior Provider Operations Representative May 2003-October 2023

Health New England

One Monarch Place

Springfield, MA 01144

Responsible for representing HNE to its provider network. I provide education, responded

to operational inquiries and acted as a liaison to several hospital systems in the Western Massachusetts area and ancillary providers nationally. I am also responsible for on-site visits and presentations to the network, providing understanding of HNE policies and procedures and ensuring buy-in to HNE initiatives. These initiatives included claim payments issues, benefit interpretation, case management and technology-based updates and changes.

Senior Member Services Representative May 1996-May 2003

Health New England

One Monarch Place

Springfield, MA 01144

Provided assistance to six Member Service Representatives in a Supervisor role while also performing all duties of a Member Service Representative to include call handling and benefit interpretation and procedures for members, providers and employer groups; also a resource for Health New England employees with benefit and claims questions; responsible from July 2001 through September 2002 for maintaining the Provider Claims Queue in a Senior Position. This included researching and interpreting claims issues for all Providers and assisting the Provider Claims Representatives with complicated claims issues as well as negative balance interpretations while also assisting the Member Queue simultaneously.

Member Service Representative November1994-May 1996

Cigna Health Care

5700 Bigelow Commons

Enfield, CT 06082

Assist members, providers and policyholders of Cigna’s HMO product with inquiries regarding benefits and protocol, billing and claims issues; extensive computer utilization in a fast-paced environment with an average of 90 calls per day.

EDUCATION

Fitchburg State College 1984-1988

Pearl Street

Fitchburg MA

Completed coursework towards degree in Journalism and English Literature

*References available upon request