Candace S. McClam

**** ****** *** *********, ** *9541 ada1u1@r.postjobfree.com

843-***-**** (Cell)

Qualifications Summary

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.

Professional Experience

Broad- Path Healthcare Solutions. 2018-2019

Claims Adjuster/Processer

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