Experienced Service and Insurance Professional

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Melissa St. Cyr

**** ********* **., **** #****

603-***-**** cell

Jacksonville, FL 32258

********@*****.***

OBJECTIVE

To obtain a position with a fast-paced, stable company where I can effectively use my strong organizational skills and years of experience with various branches of customer service within the health insurance industry.

PROFILE

A motivated and personable business professional with nine years experience working in the health insurance industry. Considerable experience and interaction with various health insurance companies as well as multiple private employers. A flexible and dedicated team member with a proven record of performance in meeting and exceeding clients’ expectations in managing their health and welfare plans. Strong background in claims processing, issues resolution and eligibility reconciliation.

PROFESSIONAL EXPERIENCE

ADP TotalSource, Inc. - Salem, NH 05/06 to Present Northeast Benefits Representative Specialist Provide administrative and customer service by phone and e-mail for maintaining clients' health, dental, vision, life, disability, and FSA plans. Identify opportunities, define problems and recommend solutions to external client contacts, internal HR Business Partners, Implementation Specialists and Payroll Service Representatives with respect to employee benefits. Administer benefit eligibility tracking, including preparing enrollment packets, keying new hire enrollments, processing status changes, maintaining client benefit files, and monitoring benefits continuation for employees on leaves of absence. Assist with the adjustment of monthly benefits bills to clients. Consult clients regarding annual open enrollment options and processes, including benefit class design, plan designs, and premium contribution strategies. Maintain knowledge of laws related to employee benefits, including Section 125, FSA, COBRA, HIPAA, and FMLA, and be able to explain and apply them to a base of clients local and national.

Oxford Health Plans (a UHC Company) - Hooksett, NH 09/00 to 05/06

Cost Containment Claims Auditor – 08/04 to 05/06 Performed audits to determine if claims have been processed according to Oxford/United Healthcare policies and procedures. Provided constructive feedback to claims personnel. Acted as a subject-matter expert on benefits, policies, procedures, and protocols. Discussed audit appeals with Supervisors. Worked as a liaison with other departments to resolve error trends. Proactively in the discovery of fraud, trends, and collections. Maintain mutually positive and open communication with the Claims Processing team.

Operations Specialist – 07/03 to 08/04 Combined role of a Customer Service Representative and Resolution Analyst; servicing member and provider calls as well as reviewing previously paid claims to determine necessity of reprocessing.

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Melissa St. Cyr – Resume

PROFESSIONAL EXPERIENCE, continued

Resolution Analyst – 07/02 to 07/03 Responsible for reviewing previously paid claims to determine accuracy based on Payment Policies submitted via correspondence or telephone calls from providers and members. Joined initial Task Force for Complaints, Appeals, and Grievances to reduce aging inventory levels in order to ensure turnaround times were maintained in accordance with several state mandates.

Customer Service Representative – 09/00 to 07/02 Call center environment to service members and providers with various inquiries regarding claim status, payment, denials, disputes, benefit inquiries, and basic standard policies and procedures. Responsible for answering calls, providing accurate information in a timely manner in order to keep call volume down.

EDUCATION

Stratford Career Institute, St. Albans, VT Certification for Medical Billing Specialist, January 2006 Southern New Hampshire University Several courses in the Accounting program, September 1999-January 2000 Majored in Accounting Manchester High School West Diploma in General Studies, June 1999

SKILLS SUMMARY

Proficient in Microsoft Office: Word, Excel, Access, Outlook and Microsoft Explorer. Can work multiple software programs and mainframe systems to complete a single task as needed. Very detail-oriented, organized, efficient and self-motivated.

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