Customer Service Representative
Resume:
Stacey A Sullivan
Albuquerque, NM 87113
*************@*****.***
Professional Profile: Extensive experience in medical underwriting and the healthcare industry. Exceptional work ethic, reliable and a team player. Work Experience:
Presbyterian Health Plan, Provider Network Operations - 2017-2022 Provider Network Relationship Associate
• Provide assistance with Long Term claims and EVV claims for my 4 Executives. Also provided assistance inputting provider information into the database to ensure provider claims would pay accurately.
• Accessed and was responsible for all Long Term Care claims in the HealthX claims system
• Responsible for ensuring that all Home Modification invoices were scanned and sent to the claims department for processing
• Replied to all prover emails as well as any internal emails
• Participated in our Provider Education Conference Presbyterian Health Plan, 2014-2017
Appeals and Grievance Coordinator
• Addressed member grievances within the required timeframes per compliance Presbyterian Health Plan, 2011-2014
Individual Medical Underwriter
● Apply medical terminology and underwriting tools in assigning risk to Individual Plan Applicants
● Asses if Individual Plan Applicants can be approved, rated up or declined
● Medical stop loss reporting on catastrophic claims for ASO groups
● Support large group and small group underwriting in evaluating the
health risks of groups
● Support manager on case investigations
Blue Cross Blue Shield of New Mexico, 2000-2011
Small Group Underwriting Analyst, 2002-2011
● Renew 2-150 life, key accounts
● Analyze prior carrier claims experience and assign rates
● Analyze and assess medical risk for renewals, proposals, and new groups (both small and large group)
● Ensure accuracy on all renewal and new group paperwork
● Perform all re-rating for small group renewals
● Prepare rates for small group renewals
Account Coordinator/Database Specialist, 2000-2002
● Processed paperwork for new, small groups
● Built and maintained the sales and underwriting database
● Manufactured all reports for the sales and marketing department American Property Management, 1997-2000
General Manager
● Managed all employees, payroll, scheduling, and all customer service issues
Stacey A Sullivan
6309 La Habra Lane
Albuquerque, NM 87113
*************@*****.***
Skills:
● Experienced with Microsoft Word, Microsoft Excel, Windows, Macintosh, Q-Basic, Telemagic, Anasazi, Saleslogix, Lotus Notes, Word Perfect, Limited SQL & Microsoft Access 2007, and all internet functions
● Outstanding customer service skills and experience
● Excellent attention to detail
● Dedicated and dependable
● Positive attitude
● Business Objects Reporting
Education:
Community College of NM-1995-1997-Arts & Sciences, and Computer Programming classes.
Eldorado High School-1992-1995, High school diploma
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