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Claims Analyst Retail Merchandiser

Location:
Charlotte, NC
Posted:
April 14, 2022

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Resume:

Sandra Moman

Charlotte, NC *****

adqsec@r.postjobfree.com

+1-617-***-****

Work Experience

Retail Merchandiser

Hallmark Cards - Kansas City, KS

June 2020 to June 2021

Responsible for replenishing Hallmark greeting cards, gift items and wrapping supplies in CVS, Walgreens, Stop n Shop, Family Dollar and Dollar Tree stores. Reset seasonal cards as directed. Processed store returns and damages. Constructed new displays.

Client Escalation Specialist

BANK OF AMERICA - Boston, MA

March 2010 to March 2012

Assist external customers and banking center associates in all phases of account opening and maintenance

Assist customers in selection of most appropriate banking solutions packages

Counsel and trouble shoot all areas of online banking

Verify status and place stop payments on official items

Correct posting and encoding errors on consumer and business accounts

Process privacy opt-out requests

Assist internal customers with inputting, cancelling and amending wire transfers

Research missing deposits for consumer and business accounts

Head team sponsored events on site

Member of site-wide Diversity Team

Member of Volunteer Team for Greater Boston Food Bank

Member of the Black Professionals Group

Installation Leader

HALLMARK MARKETING CORPORATION - Kansas City, MO

2007 to 2009

Supervised the installation crew in the revision of Hallmark aisles in drug store chains

Recruited and trained installation and merchandising representatives

Ordered fixtures and products

Processed payroll for all crew members

Senior Claims Analyst - Supervisor

MEDVENTIVE - Cambridge, MA

2004 to 2006

Supervised claims auditors in managed care claims payments to identify and initiate recovery for inappropriately adjudicated claims.

Audited Medicare claims databases for member and provider eligibility and payment issues

Consulted with provider practice management team regarding audit processes and results.

Analyzed large managed care claims databases to identify claim payment discrepancies.

Developed audit logic documentation.

Recovered $100,000 to $1.2 million in lost revenue to provider groups annually

Documentation Specialist - Harvard Pilgrim Healthcare Account Quincy, MA

PEROT SYSTEMS CORPORATION - Plano, TX

2000 to 2004

Facilitated groups of subject matter experts to develop document content.

Developed and trained claims processing guidelines using Information Mapping.

Post training documents on Claim Processing website using Microsoft FrontPage.

Facilitated quality workgroups to improve document and web conventions.

Created "Diversity at Work" a trainers guide for the account's diversity program.

Facilitated "Diversity at Work" seminars.

Selected as a Cultural Audit Team Facilitator

Recipient of the Claim Services MVP Award

Claim Processor/ Resolver I/II - Claim Services

HARVARD PILGRIM HEALTH CARE - Boston, MA

1996 to 1999

Adjudicated and adjusted paper/electronic claims based on product and members benefits.

Researched and resolved problem and high-dollar claims as assigned

Trained temporary and new claims processors

Processed coordination of benefits claims to ensure the correct insurer was paid

Processed coordination of benefits claims to ensure the correct insurer was paid.

Researched and resolved problem and high dollar claims as assigned.

Education

Master of Science in Management

EASTERN NAZARENE COLLEGE - Quincy, MA

Bachelor of Arts in Political Science and Sociology

TUFTS UNIVERSITY - Medford, MA

Skills

Customer Relationship Management

-

10+ years

Managed Care

Presentation Skills

-

10+ years

Project Management

-

5 years

Merchandising

Planograms

Content Development

Recruiting

Project leadership, management, documentation creation, audit

-

10+ years



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