LaWanda Gardiner

**** ****** ******, ************, ** 19139, (267) 44-l4-7270, adyof2@r.postjobfree.com

Profile

Motivated, outgoing, healthcare professional that is multi-faced with extensive experience in employee medical claims, client relations, and customer service. A detail oriented, ability to multi-task, resourceful, quick learner who is flexible and possess excellent communication, problem solving, interpersonal, time management, and team building skills with outstanding ability to collaborate successfully. Flexible and versatile able to maintain a sense of humor under pressure; Poised and competent with demonstrated ability to easily transcend cultural differences. Thrive in deadline-driven environments. Abilities to work at home and still be a positive, dedicated, and a self-driven person.

Skills Summary

Customer Service Inbound/Outbound General Office Skills

Medical Claims Re-pricing/Negotiator Medical Claims Processing

Employee and Provider Relations/ Team Leader

Sales/Telemarketing Data Entry (8,000 keystrokes)

Problem Solving /Disability Claims Processing/Research Analyst

Functional/Technical Skills

Microsoft (Word, Excel, and Outlook) Email Accounts, Internet Search, Windows (XP, 7, 10 and, Vista), EXP Macess, Facets, JIVA, SIRV3, Citrix, RIMS system, Luminex system, Copier Machine, Check Folding Machine, Microsoft Lync, etc

Professional Experience

Keystone Mercy (Ameri Health Caritas) Philadelphia, PA 11/2014-Present

Claims Research Analyst

Reprocess all corrected claims

Assist other Research Analyst

Process projects completely and timely according to specific directions provided for the project

Process high priority emails and projects

Reviewed Hospital and Medical Contracts in order to process projects correctly

AVON, Philadelphia, PA 5/2011-Present

Independent Representative-Part time Sales

• Managed all sales, products, and customer service to potential and current customers.

Keystone Mercy (Ameri Health Caritas) Philadelphia, PA 2/2013-11/2014

Medical Claims Examiner

Process all newly submitted claims and monitor and manage pended claims

Assist other claims examiners/Research Analyst

Process projects completely and timely according to specific directions provided for the project

Clear and concise communication regarding pended claims, service forms, and projects

24/7 Medplan, Lansdowne, PA 11/2015-5/2016

Sales Associate

Inbound calls at home from consumers

Handling and providing information about medical, dental coverage, and other offers

Taking orders from consumers who is interested in services

North American Benefits Company Wayne, PA 2/2012-2/2013

Short Term Disability Examiner

Process all short term disability claims in a timely manner.

Handled all customer service calls from providers and members

Handled the mailing of disability checks.

Work At Home Pastor Bless Club/Arise, Philadelphia, PA 1/2011-2/2013

Arise Certified Professional

Customer Service Representative/ Sales-Contract Work from Home

Handled inbound and outbound customer service calls from small business owners and individual’s regarding AT&T wireless accounts.

Resolved all billing issues.

Managed technical issues by troubleshooting handsets from the AT&T computer software.

Handled all inbound sales calls from potential customers for Orkin Pest Control Company

Benefits Services of PA, Philadelphia, PA 7/2007-5/2010

Medical Claims Examiner/Customer Service

Processed medical claims for thirty eight small groups.

Handled inbound and outbound customer service calls from members, providers, and PPO networks.

Handled all correspondence; such as accident details, medical records, and predeterminations.

Handled data entry of all claims not received through EDI.

Insurance Overload Staffing, Bala Cynwyd, PA 11/2004-5/2007

Insurance Related Contract Assignments

North American Benefits-Disability Claims Examiner/Customer Service

Amalgamated Life Insurance-Medical Claims Examiner

Handled processing of disability claims, maintained a quota of 35-50 claims a day.

Handled inbound and outbound customer service calls to patients and providers.

Organized new and old disability files for easy lookups when needed.

Repriced all medical claims before finalizing payments.

21st Century Health & Benefits, Philadelphia, PA 7/1998-11/2004

Senior Claims Analyst/Customer Service/Repricer

Processed all medical claims and some dental claims.

Handled inbound and outbound customer service calls from patients, providers, and PPO network.

Managed others in the re-pricing and provider relation department.

Maintained all provider records; updating address and tax id information.

Handled the submission of incoming EDI claims.

Repriced all medical claims before finalizing payments

HIPPA Certified

Education

Allied Health Institute, Certified Medical Office Assistant in Healthcare Administration

Online Course-completed-2012

Allied Health Institute, Healthcare Management (Associates Degree), Online Course-anticipated completion- 2015

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