Claims Analyst Retail Merchandiser
Resume:
Sandra Moman
Charlotte, NC *****
*************@*****.***
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
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10+ years
Managed Care
Presentation Skills
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10+ years
Project Management
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5 years
Merchandising
Planograms
Content Development
Recruiting
Project leadership, management, documentation creation, audit
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10+ years
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