Lisa M. Bonanni

210-***-**** adxlp3@r.postjobfree.com

Benefits Processing Claims Processing Community Volunteer Mortgage Insurance SUMMARY OF SKILLS

• 10 + years customer service

• 10+ years media experience

• Claims processing

• Eligibility & Enrollment

• Escrow Insurance processing

• 7+ years community service organizing

PROFESSIONAL EXPERIENCE

CAPROCK (90 DEGREE BENEFITS)

Plan Service Reprensentative

August 2020 – October 2021

Responsible for processing and adjudicating medical, dental, vision, flex and or disability claims according to the industry standards and practices. The examiner must meet high quality and production standards and practices. The examiner must meet high quality and production standards as defined by management and be able to interpret plan contract language and apply appropriate benefit coverages based on the plan provisions outline in the Plan Document. Process complex claims for physician, hospital and specialty areas with high degree of accuracy and productivity.

Process adjustments, refunds and return checks according to company policies and procedures

Process claims to established dollar authority.

Respond timely to all written appeals and Department of Insurance requests. Complete stop loss disclosure packets and process stop loss claims accurately and timely.

Handle all claim negotiations and case management claims accurately and timely. Assists in customer service calls when necessary without sacrificing quality. Tests new benefits, new client implementations or product enhancements. Provides assistance and serves as a mentor to team members. Assist Director in providing reports when necessary. Identifies process improvement opportunities and works to implement corrective actions.

Assist with claims documentation, training and education. Overtime, as required.

Prompt and regular attendance

• Provide daily support for the customer service unit by handling escalated and/ or complex calls.

• Take, respond, and provide a high level of consumer education to members and customers regarding telephonic or email inquiries on eligibility, benefits and claim status with a high level of accuracy.

• Handle and resolve customer service reworks within established TATs and with high accuracy.

• Ability to review & adjust claims in WLT sent by Reps for correction.

• Provide training support and trending analysis to management to support process improvement.

Key Strengths

• Ability to multi task in a fast-

paced environment

• Excellent verbal and written

communications skills

• Adaptability

• Achievement Focus

• Business Acumen

• Process Improvements

• Computer & Software literate

• Dependability

• Excellent attendance

Leadership Skills

• Ability to lead and inspire others

to achieve business goals

• Training and team development

• Strong interpersonal skills

• Judgeship Campaign organizer

• Key contributor

Community Service Awards

• San Antonio Business Journal

Corporate Philanthropy & Non

Profit

• United Way Volunteer of The Year

• Respond to inter-departmental inquiries within established time frames; provide detailed and thorough responses to same.

• Make outbound calls on the member’s behalf to various Providers or other entities in order to help coordinate care or resolve claim/ benefit questions.

• Utilizes appropriate tools and resources to answer and document all customer inquiries.

• Works and supports the team environment in order to meet both individual and team objectives.

• Overtime, as required.

PROVIDENCE INSURANCE

GH Examiner

August 2019 – August 2020

Maintain punctuality and attendance, analyze group health claims, Inbound/Outbound calls from/to members and providers, Primary contact for Broker and Clients, Clerical support tasks as assigned, Verification with networks regarding repricing and eligibility, additional duties or projects as assigned by management.

A claims examiner is a person who reviews, processes, and approves or rejects insurance claims They work behind the desk, mostly by telephone and mail, and ensure that claimants and adjusters follow the proper procedures and legal compliance. They may also assist adjusters with challenging or disputed claims, investigate fraud, compile reports, and take part in litigation. Depending on the type of insurance, they may also assess medical charges, causes of death, or policy applications. They provide a high level of customer service and document their decisions

BENEFITS MANAGEMENT ADMINISTRATORS (BMA)

April 2018 – April 2019

ELIGBILITY &ENROLLMENT SPECIALIST

Process enrollment applications from portal transactions, faxes, files or emails for group Medical, Dental, Vision and COBRA coverages, Including Flex enrollment. Print and mail ID cards, packets, process ACH payments. Key contributor during open enrollment and group renewals. Interact daily with Insurance companies, HR managers and Brokers about enrollment.

Process additions, terminations and changes in the enrollment system on a daily basis Coordinate open enrollment processes for all new and renewing groups in concert with Account Management and Implementation.

Manually process carrier changes as necessary.

Maintain turnaround times in accordance with company policies. Process ID card requests as needed.

Process COBRA transactions in the Eligibility system. Provide backup to customer service agents as necessary. All other duties as assigned.

ROJAS LAW FIRM

OFFICE MANAGER

Nov 2017 – April 2018 (OFFICE MANAGER)

April 2019 – August 2019

Keep clients informed of hearings and appointments. Maintain office files and client payments. Follow up on judges’ orders and arrange meetings with opposing counsel. Assistant for judgeship campaign for 288th District Judge in the 2018 election. Coordinate and oversee administrative duties in an office, and ensure that the office operates efficiently and smoothly. Their responsibilities generally include duties greeting clients, managing office supplies, overseeing other administrative staff, owning budgets, and supporting staff with administrative tasks like scheduling meetings. UNITED HEALTH GROUP

CLAIMS REPRESENTATIVE ASSOCIATE

Feb 2017 – Nov 2017

Process incoming insurance claims, reviewing, researching, and analyzing complex insurance claims of multiple insurance products with multiple levels of benefits within each product.

analyzing complex healthcare claims that require research to determine action steps and mathematical calculations necessary to produce an accurate payment. The claims position requires a high level of quality which is to be maintained while achieving a productivity goal. You’ll put your skills and talents to work as you review, research, and process medical claims. It's complex, detailed work. It's a fast-paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e.g. verify pricing, prior authorizations, applicable benefits)

Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool) Independently complete daily all documentation and communicate the status of claims as needed adhering to all reporting requirements Communicate through correspondence with members and providers regarding claim payment or required information, using clear, simple language to ensure understanding

Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors)

Meet and maintain the performance goals established for the position in the areas of quality, production and attendance Consistent attendance with ability to meet work schedule including the required training period Successful completion of the UnitedHealth Group 12 to 14-week new hire training program which is 60% instructor lead and 40% self-paced learning (requires ability to read complex information and demonstrate proficiency through testing and practical application) SWBC (SOUTHWEST BUSINESS CORPORATION) ESCROW

SENIOR DATA INTEGRITY SPECIALIST

June 2015 – Sep 2016

Process insurance through escrow for various major banks on mortgage and auto loans. Promoted to team lead and managed a group of 20 representatives which included training and employee development.

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