Customer Service Insurance
Resume:
Kathy Talley
Urbanna, VA *****
SUMMARY OF QUALIFICATIONS AND ABILITIES
Recognized by employers as a dedicated, hard-working employee with impeccable work ethic. Extremely well organized, dependable, and intelligent. Able to set priorities, work independently, and meet deadlines. Friendly, with a positive attitude. Eager to learn and accept additional responsibilities and assignments. Able to telecommute and work from home. Excellent project management, problem analysis, critical thinking and documentation skills. Possess advanced working knowledge of Word, Excel, Access, and Outlook, in addition to Test Director, Peregrine, and several Web based applications. Able to quickly learn and master new software applications. Very familiar with the insurance industry and PHI guidelines.
WORK EXPERIENCE
2011 – Current Elder care – self employed
• In home care for the elderly recovering from recent surgeries including light medical care, travel and house hold duties.
Anthem Blue Cross and Blue Shield
Richmond, Virginia
2004 - 2011 BUSINESS ANALYST
• Serve as Lead Business Analyst assigned to the company’s electronic enrollment system through which about 25% of the enrollments are processed
• Analyze, document, and System and User Acceptance test code changes to enhance and upgrade the enrollment application hardware and software
• Solve complex business problems and recommend improvements to efficiency and productivity affecting process flow and data integration including writing PR’s and Requirements
• Provide valuable information about the correlation between insurance rules and system capabilities to determine best practices and process improvements
• Write requirements based on business needs and technical parameters
• Lead Business Team and mentor new associates and resources new to the team
• Communicate with external and internal customers including directors, managers, and end users
• Manage day to day operations of the components of the electronic enrollment system
• Create management reports and presentations
• Promoted from Business Analyst I to Business Analyst II in April 2005
• Abide by PHI-Personal Health Information guidelines.
2000 – 2004 CASE ADMINISTRATOR
• Customer Advocate for sales, brokers and group administrators to collect the information needed to handle dedicated group accounts
• Posting of all monthly premium payments for group reconciliation
• Direct contact with the finance department for the appropriate posting of premium payments
• Direct contact with all group administrators and human resource managers for information regarding employment status and change
• Assisting with changes needed for the retention of existing accounts
• Work independently to adjudicate proper payment, reconciliation and maintenance of records
1999 – 2000 FAIR BUSINESS – SPECIAL UNIT REPRESENTATIVE
• Audit all claims to ensure that Anthem is in compliance with state mandated laws
• Check benefits for quality and give feedback to Anthem employees for proper adjudication
• Reviewed HIPAA return letters to update our Corporate Membership and CHIPS – Claims processing Systems so claims may be reopened for adjudication
• Have assisted management on multiple projects for accuracy and compliance on hospital, medical, dental and vision claims. Written procedures to make the process more efficient
• Worked with a large team to ensure all work was complete in a timely fashion on a daily basis
• Was responsible for keep track of inventory for management, reporting trends in claims processing and gave feedback to management
1996 – 1999 CUSTOMER ADVOCATE
• Customer Advocate in a multifunctional position
• Maintained processing of claims in a team environment
• Provided written documentation to other areas to develop training procedures for vision, dental and durable medical equipment
• Responsible for on the job training for existing and new employees regarding questions and day to day workflow
• Checked quality for accuracy, process versus plan documents and group benefits
• Worked in a team environment with willingness to assist my peers
1987 - 1996 SENIOR SERVICE COORDINATOR – (Trigon Administrators – TPA)
• Maintained accounts including written and oral communication with sales, brokers, group administrators, employers, employees and providers
• Maintained complete process of the benefit plan provided to the group including customer service, provider service, group enrollment and adjudication of claims
• Responsible for ongoing training of existing and newly hired employees
• Moved into a Team Leader position to lead a team of eight. Monitored team’s performance, inventory, audit and reporting
• Migrated to a new processing system. Assisted technical support to build the system for benefits and procedure for process
1986 - 1987 COMPREHENSIVE CLAIMS REPRESENTATIVE – (Trigon Administrators – TPA)
• Benefit analyst for the claims processing system. Writing procedures for training in a class setting and on the floor assistance
• Multifunctional daily performance for customer support
John P. Pearl & Associates, Ltd.
Richmond, Virginia
1983 - 1986 LIFE INSURANCE CLAIMS REPRESENTATIVE – John P. Pearl & Assoc. Ltd.
• Maintained billing accounts for Group Life, Health and AD & D
• Administration of premium summaries, underwriting requirements and policies
• Posted accounts receivable and termination of contracts
• Maintained accurate records of group coverage
EDUCATION
• General Education Diploma
RELEVANT EXPERIENCE
• Lead liaison between Electronic Enrollment Team and Web Technical Support responsible for ensuring correct and complete file transactions
• Possess advanced knowledge of multiple functions within an insurance company environment, and capable of communicating with others about insurance related issues and topics
• Excellent multi-tasking and communication skills
Contact this candidate