Candace S. McClam
Highly personable Customer Service Professional with years of experience in configuration, benefits analyst, account management, claims processing, and call-center operations within the insurance, and entertainment industries.
Proficient in processing claims using systems such as ie…Facets, Medical Manager, Diamonds, and ICD-9, ICD 10 and CPT coding.
Expertise in resolving escalated benefit configuration issues.
Proficient with Microsoft Office System (including Microsoft Word, Microsoft Excel, SQL, Microsoft PowerPoint®, Microsoft Access, and Microsoft Outlook®).
Demonstrated ability to gain customer trust and provide exceptional follow-up, leading to increased repeat and referral business.
Broad- Path Healthcare Solutions. 2018-2019
Processed and corrected claims based on denial errors
Made adjustments based on CMS guidelines and Federal Regulations
Researched claim denials in order to make sure claims were processing according to provider contract
United Healthcare- Telecommute
Benefits Configuration Analyst. 2015 to 2018
Workflow support and Facets benefit configuration
Became proficient with using Facets and SQL in order to review Medicare and Medicaid tickets
Completed research and worked projects based on Configuration changes that needed to be made within the system.
Utilized special macros and spreadsheets to research provider inquiries, pends, and Research tickets from members and providers.
Proficient using Facets, IDIRS, SQL (GFO), Access, Query tools
Aon Hewitt- Winston Salem, NC 2014 to 2015
Customer Service Representative
Assisted customers with enrolling into their medical insurance
Provided customer service to participants enrolling into their spending accounts
Utilized different systems to process enrollment per client restrictions and guidelines
Broad-path Healthcare Solutions- travel 2013-2014
Oversaw operations of daily reprocessing of claims.
Processed Medicare and Medicaid claims per CMS and government guidelines
Reprocessed rejected claims for payment using federal and states guidelines
Value Option- Customer Service Representative 2006-2007
Processed medical claims for patients and providers
Adjusted, configured, and audited claims.
Became familiar with ICD-9 coding and CPT codes.
Education and Training
Reference available upon Request