Sales Agents Health Plan
Resume:
Sioux Falls, SD *****
***********@*****.***
KIM PEACE
OBJECTIVE
To continue my career in the medical field and utilize my outgoing, can-do attitude and knowledge in an atmosphere that will benefit from these strengths.
SKILLS & ABILITIES
Attention to detail, adaptable and flexible, able to work from multiple different systems, good with people, excellent communication skills, hardworking and dedicated.
EXPERIENCE
SANFORD HEALTH PLAN – OPERATIONS ASSISTANT
2021-current
Licensure in Health Insurance. Assign lead information to appropriate sales agents, send benefit information to interested potential enrollees, send ID card information to agents as the come through the system, research and track ID cards for new members and escalate, schedule and track events for live and virtual events for sales agents in Outlook, do Service Requests for transfer from one facility to another or complete discharge, handle member requests in Health Suite appropriately. Investigate and correct discrepancies between Sales Force and Health Suite. Schedule Preventive Virtual appointments with members.
SANFORD HEALTH PLAN – AUDITOR
2017-2021
Did 2% audit of different lines of business on claims to assure they were following correct reimbursement policies and benefit information. Completed letter audits. Worked closely with provider relations to set up new provider groups and audited their work.
SANFORD HEALTH PLAN – MEMBER SERVICES REPRESENTATIVE
2015-2017
Answered incoming and made outgoing calls, responded to emails, assisted providers and members with claim payments, created excel spreadsheets for various projects. Returned calls on messages left after hours. Gave benefit information and explained where they were with deductible and max out of pocket on claims. Checked to see if providers were in or out of network.
SANFORD BILLING OFFICE – PATIENT ACCOUNT REPRESENTATIVE
2006-2015
Answered questions on clinic and hospital billing claims and explained how insurance processed as well as educated on deductibles and max out of pockets. Collected on past due accounts and set up payment plans.
EDUCATION
COLORADO TECHNICAL INSTITUTE – SIOUX FALLS, SD
Degree of Medical Assisting – 2003, GPA 3.81
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