Heath Insurance
Resume:
Frances Jeffers
Gainesville, FL *****
352-***-**** - ***************@*****.***
Professional Summary
To seek and maintain full-time position in the health insurance industry which offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Results oriented professional with excellent leadership and interpersonal skills.
Skills
Amisys
Healthy Rules Payor (HRP)
EXP Macess
Salesforce
Developing and creating team relationships.
Excellent verbal and written communication skills
Work History
05/2019 to 03/2023
Supervisor of Coordination of Benefits and Overpayment units.
NTT DATA Services – Gainesville, FL
Led and monitored staff performance.
Hired and trained new staff.
Held key position in claims department during AvMed's transition to outsourced vendor (NTT Data) and new software.
Subject matter expert in transitioning from Amisys software to Healthy Rules Payor (HRP).
Tested new software for initial transition and new group enrollment.
Developed desk top level procedures for processing claims, ie COB, creating receivables and check posting in HRP.
Resolved provider's and member's claims issues received from Call centers.
11/2004 to 05/2019
Claims Supervisor
AvMed Health Plans – Gainesville, FL
COB Supervisor: 04/17-05/19
COB & Claims Review Supervisor: 12/11-04/14
Adjudication Supervisor: 11/04-12-11
Supervised and led team of 13-20.
Responsible for statewide coordination of benefits.
Responsible for accurate and prompt resolution of member and provider claim issues.
Responsible for preexisting investigation.
Monitored turnaround time.
Ensured quality and production standards met by team.
Monitored team performance, enforcing compliance with corporate claims processes and procedures.
Assisted staff training in adjudication, claims review, preexisting investigation and COB.
Responsible for training and developing New Claims Supervisor.
Configuration Analyst: 02/14-04/17
Pricing and Benefit configuration.
Tested new benefit products.
Resolved provider pricing and member benefit issues in timely manner.
10/1999 to 11/2004
Claims Operations
AvMed Health Plans – Gainesville, FL
Various Positions:
COB Coordinator
Adjustment Coordinator
Claims Reviewer
Claims Examiner
Education
Bachelor of Science: Business Administration
University of Florida - Gainesville, FL
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