Deressa Walls

**** ***** **** ***** *******, TN. 38016 adxt70@r.postjobfree.com

Telephone #: 901-***-**** or 901-***-****

Summary of Qualifications:

Thirty-eight plus years of experience working in the business field with demonstrated capabilities:

Medical Insurance & Claims processing

Extensive knowledge of Medicare & third-party payers

Ability to analyze and resolve claim issues & other employee problems

Excellent Interpersonal & communication skills

Commendations for exceptional work; able to assume responsibility necessary to get the job done

Able to work well in a team and/or independently completing assignment with integrity adhering to company rules/regulations

Computer Skills:

Advanced skills in: Windows; Word Processing; Spreadsheets & databases; Microsoft Word; Works; Excel; PowerPoint; Access, Oracle system

Education:

Strayer University, Memphis, Tennessee – BBA Business Administration/Human Resource Management - Graduated May 2010. GPA: 3.40

Professional Experience

Memphis Light, Gas & Water, Memphis, Tennessee 12/2022 – 04/2023

Human Resources Representative II – (Contractor)

Company Insurance/Benefits Program (HR)

Assist Supervisor and Manager with day-to-day procedures

Research, analyze and investigate various complaints, claims, charges, and handled inquiries regarding benefits

Assist outside Auditors with Insurance Benefits Department yearly audit

Communicate benefits to active, retirees, & COBRA participants groups

Work on special projects as assigned

Memphis Light, Gas & Water, Memphis, Tennessee 01/2021 – 09/2021 Human Resources Representative II – (Contractor)

Company Insurance/Benefits Program (HR)

Facilitate 3rd party recovery procedures; Research, analyze and investigate various complaints, medical insurance claims, charges and inquiries concerning human resource issues & review of claim processes

Knowledgeable of Medicare/COBRA rules/regulations; COBRA/HIPPA laws and other federal regulations relating to Insurance & HR Benefits

Assist new Supervisor & Manager of Benefits Department with office procedures & staff

Handle complaints and questions from active and retired employees, vendors, physician offices, external and other internal departments

Stay abreast of medical terminology, claims operating procedures, system developments relating to claims processing and healthcare legislation impacting the Division’s medical plan and benefits

Updated office procedures manual for Insurance/Benefits Departmental Staff as needed

Communicate benefits to employee/retiree groups

Worked on special projects as assigned

Memphis Light, Gas & Water, Memphis, Tennessee 11/2018 – 08/2020

Human Resources Representative II – (Contractor)

Company Insurance/Benefits Program (HR)

Facilitate 3rd party recovery procedures; Research, analyze and investigate various complaints, claims, charges, and inquiries concerning human resource issues & review of claim processes

Knowledgeable of Medicare/COBRA rules/regulations; COBRA/HIPPA laws and other federal regulations relating to Insurance & HR Benefits

Assist new Supervisor and Manager of Benefits Department with office procedures and staff

Handle complaints and questions from active and retired employees, vendors, & other internal departments

Stay abreast of medical terminology, claims operating procedures, and system developments relating to claims processing and healthcare legislation impacting the Division’s medical plan and benefits

Developed office procedures manual for Insurance/Benefits Departmental Staff

Communicate benefits to employee/retiree groups

Worked on special projects as assigned

Memphis Light, Gas & Water, Memphis, Tennessee 02/1989 – 10/2014

Chief Clerk (Foreman) – Company Insurance/Benefits Program (HR)

Train, direct, supervise employees; schedule, assign & coordinate the processing of medical claims & maintenance of benefit-related records

Maintaining hard copy records & data entry into individual & company computer system accounts (premiums, pensions, enrollments/changes, refunds, salary continuation, Express Scripts mail order drug program, authorizations/pre-certifications & more)

Knowledgeable of Medicare/COBRA rules/regulations; COBRA/HIPPA laws, & FMLA

Audit Reports: quality assurance to ensure accuracy of claims processed; facilitate 3rd party recovery procedures; perform weekly claim audits; research, analyze & investigate customer disputes/complaints

Assist with coordinating open enrollment.

Perform new hire orientation to new employees

Liaison for MLGW w/medical service providers; interpret/implement PPO contract provider provisions; determine & calculate fee schedule percentages; prepare monthly payment statements for providers and more

Assist with daily operations of group benefit programs (health, vision, dental, STD/LTD, FSP, wellness, life insurance & other benefits

Printed weekly claim checks to providers. In charge of printing provider checks totaling millions of dollars

Worked on special projects as assigned

Note: Retired from MLGW October 31, 2014

Contact this candidate