Medical Life Insurance

GINA K. NOMELLINI

***** ** ***** ** **** ****, Snoqualmie, WA 98065

425-***-**** or 425-***-**** ********@*****.***

HUMAN RESOURCES BENEFIT SPECIALIST

Symetra Life Insurance Company, Bellevue, WA August 1989-June 2011

SR. EXCESS LOSS AUDITOR

• High level ability to audit Individual Excess Loss claim submissions through analysis of excess loss policy provisions, employer plan document provisions, administrative agreements, and cost containment vendor agreements to process accurate claim reimbursements.

• Determined and obtained all information necessary for approval /denial of self-funded claims in order to manage the accurate disbursement of liability, provided quality, cost effective, timely service to clients, and aided in the retention of business.

• Managed as a subject matter expert on all phases of claims, including, but not limited to, audit, complex claim handling, claims business decisions, and trouble-shooting for resolution.

• Interacted with internal and external customers to provide educational and technical support in a manner that achieved strong working relationships (Third party Administrators, policyholders, agents, field personnel, and underwriters), and traveled to many employers to develop a close rapport with Symetra and their clients.

• Analyzed potential claim notices and claim submissions for cost containment opportunities and referred to Medical Risk Consultants or Vendors for intervention.

• An expert in group health insurance, ERISA employee benefits plans and reinsurance.

• Proficient in medical terminology, use of ICD-9 and CPT coding, UB92 identifiers, and HCFA forms.

• Knowledgeable in industry and legal parameters regarding coordination of benefits, rights of recovery and subrogation.

• Ability to use varying resources, research diagnosis, treatments and average costs for application to claims decisions, underwriting support and claim opinion inquiries.

• Strong analytical and contract interpretation skills

• Strong communication skills (oral and written)

• Independent judgment and objective decision-making skills

• Ability to work with deadlines

• Function effectively in a changing environment

• Personal computer experience, proven abilities in MS Word, Excel and related applications

• Ability to work in a team environment and exhibit leadership skills.

G.K NOMELLINI Page 2 of 2-425-***-**** ********@*****.***

35307 SE Aspen LN Unit 1102

Snoqualmie, WA 98065

LIFE CLAIMS AUDITOR

. Acted as intermediary with policyholders, insured employees, beneficiaries and their

representatives. Adjudicated group life insurance, accidental dismemberment, accelerated benefit claims.

. Facilitated waiver of premium disability claims.

. Ability to develop sufficient and valid evidence, and make formal determinations on

complex factual, legal and medical factors.

. Great strength in expressing information clearly, both written and verbally.

. Assisted with the oversight of the claim paying vendor.

. Served as a resource for internal and external customers by answering claim and

contract questions.

. Responsible for training, including preparation of training materials, for both internal and external customers.

. Analytical and general mathematical skills.

. Experience with insurance concepts, practices and procedures.

. Knowledge of medical, legal and insurance terminology.

. A wide degree of initiative and judgment.

. Strong attention to detail.

MEDICAL RISK MANAGEMENT EXAMINER

. Coordinated referrals from TPAs and resolved any eligibility issues at the claimant and policy level.

. Assured accuracy/integrity of financial savings.

. Promoted MRC services during renewals.

.Coordinated any outside audits such as hospital audits or other cost containment services.

. Managed complex medical/contractual issues.

. Proficient negotiation and problem solving skills.

. Reviewed plan documents to assure that claimant qualifies for services based on eligibility, COBRA, LOA, FLMA etc.

. Reviewed all bills from providers for complaiance with negotiated agreements and coordinated with TPA.

EDUCATION

Bachelor of Science, Psychology, Washington State University, Pullman WA 1987

Minor in Sociology

Minor in Alcohol Studies

TRAINING & PROFESSIONAL DEVELOPMENT

Successful Completion of the Alcoholism Training Program at Washington State University

Successful Completion of Dale Carnegie Training Course, Public Speaking Mastery, Bellevue, WA

Successful Completion of STRENGTHS FINDER 2.0 Course, Bellevue, WA

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