Profile

Talented, results-oriented leader with a proven record of accomplishments in achieving business goals and objectives. Demonstrated success through the implementation of key projects. Solid leadership skills - able to build and guide top performing teams. Strong verbal communication skills with management, vendors and customers.

Professional Highlights

Strong oral, written and listening skills

Team Building and Management

Customer Service Oriented

Deadline Driven

Multi-Tasking Skills

Proficient in Microsoft Word and Excel

Production Processes

Conflict Resolution

Inventory Management

Analytical Skills

Education

Pursuing Bachelor Degree in Business Management January, 2023

Pershing High School Graduate June, 1991

Experience

Unit Leader

FCO Home BlueCard and Flexlink Claims 2017-Present

Responsible for monitoring processing claims and adjustments for the Flexlink customers.

Process and supports MESSA shared claims processing arrangement.

Process claims in the OPTUM platform.

Monitor and assign claims COB claims.

Process and monitor claims in Navigator and Ncompass.

Decrease and Increase adjustments.

Unit Leader

Host BlueCard Claims Process & Blue Card Provider Advocate 2012-2017

Oversee a unit of 12 claim adjudicators ensuring that claims are processed in accordance with Blue Cross Blue Shield Association index performance measures.

Provide performance feedback to employees and department management.

Facilitate communication with other Blue Cross Blue Shield Plans as necessary.

Review inventories and planned receipts against planned available productions hours and production per hour standards.

Indentify the causes and delays of the aging of aged claims.

Assist supervisor and develop a daily production strategy to ensure that control over aged claims & inventories are met.

Analyze daily individual production to ensure standards are met.

Indentify/clarify processing procedures/problems and contact other Unit Leaders/analyst in other Sections for additional manpower.

Maintain an effective inter/intra –departmental relationship with all levels of management.

Answers/clarifies technical/benefit questions/issues

Facilitate weekly huddles with supervisors/performance evaluation specialist to provide on the job training, coaching and development

BlueCard Claims 2003-2012

BlueCard Claims Adjudicator

Utilize claim finalization techniques with demand a thorough knowledge of facility/professional and case management claims processing.

Process complex priority cases and inquires for approval denial which requires high level of expertise in pricing.

Contact Michigan Provider’s to obtain additional information needed to finalize the claim.

Maintaining and processing Host medical records

References are available.

Contact this candidate