*** ******* **

Manchester, NH *****

Phone 603-***-****

E-mail adygfv@r.postjobfree.com

adygfv@r.postjobfree.com

Meliha Medic

I am seeking a role that will benefit from my organizational skills, communication skills as well as my experience. I am looking for an opportunity that will challenge me and that will give me a chance to grow with the company.

Work experience

06/21- Present- National EBA Implementation Coordinator/ Benefit Analyst III

Liaison between EBA and Client Success/Client Management teams.

Responsible for communication and tracking of EBA work efforts throughout the implementation to ensure timely completion.

Conducts quality audits of the new benefit plan designs.

Develops and implements tracking mechanisms and tools for EBA implementations.

Leads projects related to EBA implementation.

Responsible for identifying complex business needs and translates the needs into application software requirements in support of operations, productions and projects.

Primary duties may include but are not limited to: Designs and builds new complex non-standard benefit plans, reviews and analyze benefit summaries; and identifies best approach to code/develop benefits to achieve optimum adjudication levels.

Maintains avoidance to negative financial, regulatory, and operational impact.

Performs testing and quality assurance of new product developed. Research and analysis of RFP proposals, and product projects.

Create and maintain issue log on appropriate tool, resolve defects based on knowledge and analysis of system functionality.

Researches and responds to complex inquiries from various departments. May consult with and mentoring of less experienced team members. Serves as trainer for standard and highly customized benefit configuration. Represents department in production related meetings including product development, design, and implementation.

07/19-06/21- Anthem Implementation Coordinator

Project manage new case implementation activities and serve as a liaison between the Account Management team, Sales team, Sales Support and customers.

Ensure completion of all critical deliverables from multiple disciplines to assure timely and accurate implementation of our customers' benefit plans.

Accountable for the accuracy, timeliness, and completeness of the implementation process.

Develop effective relationships with existing new accounts and internal departments, such as Sales Support Services, Operations, Sales, and Underwriting.

Work with Director, Account Management Services on tracking, monitoring, and reporting progress of all functional areas throughout the implementation process.

Help to develop tools and best practices necessary to improve installations.

Provide on-going root cause analysis; identifies opportunities for process improvement.

Act as primary contact/liaison between customers to resolve issues related to implementation plan design and customer deliverables.

Support Sales and Sales Support teams in developing prospects and responding to RFPs and actively participates in finalist meetings.

Lead corporate projects as assigned, develops and implements tracking mechanisms and tools for account implementation.

11/18-07/19- ANTHEM Sales Support Specialist

Acct Install & Support

Responsible for promoting product line success. Primary duties:

Coordinated with proposal units on RFP responses to brokers and groups and maintained various system updates for proposal and sales activity.

Worked with Sales Account Executives and Account Management personnel in selling, servicing and retaining brokers and clients.

Assisted in the development and oversees the implementation of policies and procedures.

Evaluated and recommended changes in procedures or methods in areas that affect the sales support team.

Audited inquiries and phone calls to ensure compliance.

Coordinated training and communication of procedure changes for sales assistants and sales representatives.

Completed projects as requested by sales directors.

Directly supported the Sales Managers in the regions assigned in the acquisition of new business, in such activities as open enrollment meetings, administrative projects and support team activities.

10/08-11/2018 Wellpoint Anthem Blue Cross Blue Shield

Enrollment and Billing Rep III- Firm Installation

WORKED CLOSELY WITH OUR TEAM IN CT processing LARGE GROUP new and renewing business

Responsible for group enrollment, billing activities and maintaining assigned accounts for Large Group

I Verified enrollment status, made changes to records, researched and resolved enrollment system rejections; Addressed a variety of enrollment questions or concerns received by mail. Responsible for all billing and delinquency processes for assigned groups. Ensured accuracy and timeliness of the billing function. Responded to inquiries concerning enrollment processes. Maintained enrollment database. Ordered Identification Cards. Determined eligibility and applied contract language for each case assigned. Performed error output resolution for electronic eligibility and processed error discrepancy list.

Handled NHADA account until recently where offshore took over. I am still the main contact for this account

Consistently achieved strong quality and productivity results.

Experienced in analyzing and working with systems such as ACES, .NET, MCW, Info Pac, BPM, Clear Quest, EGI, and Web Enrollment.

Comfortable with issue resolution

Work very closely with the Sales Team in group issue resolution as well as processing

Primary installer for HealthTrust

[ 07/05-10/08 ] Wellpoint UNICARE Andover, MA

Claims Representative I 2005-2006

Learning the tasks associated with claims processing. Trained for 8 weeks.. My work was reviewed for technical accuracy and soundness. Coded and processed claims forms for payment ensuring all information was supplied before eligible payments were made. Researched and analyzed claims issues. Had high quality and quantity production.

Claims Representative II 2006-2007

Keyed, processed and adjusted health claims in accordance with claims policies and procedures. Worked without significant guidance with basic understanding of multiple products (HMO, PPO, COB, etc). Able to handle more complex claims. Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits and healthcare terminology. Good working knowledge of claims and products. Excellent knowledge of the various operations of the organization, products, and services. Reviewed, analyzed and processed claims related to events to determine extent of company’s liability and entitlement. Researched and analyzed claims issues. Trained on the new 2.0 system. Helped with testing of claims to make sure the system was working properly.

Claims Representative III Technical Unit 2007-10/2008

Fully proficient in all key areas: perform many complex functions. Participated in claims workflow projects. Adjust, void and reopen claims. Since in this unit, I do Claim Adjustments, Checks, Deposits and Repays. Applying and creating overpayments when needed. Also do Stop Pays. I have trained new employees on Re-Establishing old claims from the old system to the new system. Also have trained employees on Checks..

01/04-07/05 Automated Medical Systems Salem, NH

Medical Billing Company. Did Billing for numerous Providers.

Took calls from patients, providers, insurance companies and collection agencies regarding billing issues. Trained new associates on the system and customer service calls. Made sure we did the billing correctly to both insurance companies and patients. Responsible for processing bills and payments and reconciling billing conflicts.

01/03-01/04 Manchester Community Health Center Manchester, NH

Front desk. Checked patients in to the office. Took incoming calls. Made appointments. Interpreting for Bosnian speaking patients.

Education

Southern NH University Manchester, NH

BS Finance

Languages

Fluent in Bosnian and English both oral and written

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