Project Manager Training

SUDHA VORA

**** ***** ******* *****

Sugar Land, TX 77479

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Education Graduated from RLM College in Maharashtra, India, degree in Commerce 1975

Experience Blue Cross Blue Shield-Houston, TX 1996-Present Unit Supervisor 2007-Present

Responsible for supervision and overseeing daily duties of support staff

Piloted a new department (Blue Care Connection) in Houston for Wellness and Disease management

Responsible for hiring and maintaining support staff

Generate reports for all groups and observe calls and payroll

Provide leadership and guidance to team to meet production, quality standards, workload management

Handle Payroll and HR related issues for employees including paid time off record

Ensure staff is equipped with all the necessary training and knowledge

Communicate all necessary information to inform staff of team and company updates

Make certain all priority groups are handled on a timely basis and all incentives are considered while educating members on the BCC program

Create ongoing PG groups deadlines for meeting goals

Use technical expertise to ensure timeliness of contract standards and ensuring customer satisfaction

Piloted new system PAD predictive auto dialer in which software makes phone calls to members and if answered, then able to explain the program and handle issues

Piloted the campaign calls from FSU to BCC.

Senior Claims Technician 2004-2007

Processed high dollar stop loss claims and difficult level facility and professional claims

Also processed Managed Care/Continued Healthcare/Medicare and ESRD claims

Assessed quality standards for the claims department and entry level claim examiners

Provided training and feedback to the claims staff

Heavily involved in research and reporting for PG accounts.

Auditor (Aetna/NYLCARE) 2001-2004

Assessed quality standards for the claims department and entry level claim examiners

Ensured accuracy for claims and paid special attention to detail

Provided training and feedback to the claims staff

Special Project Manager (Aetna/NYLCARE) 1999-2001

Investigated, researched and paid various claims such as settlement claims, overpaid claims and negotiated claims

Assisted development with training and helping low producing employees to bring them to corporate level goals

Made suggestions to enhance procedural and corporate training guidelines

Facility Claims Examiner (Aetna/NYLCARE) 1997-1999

Processed high dollar stop loss claims and difficult facility claims according to provider contracts

Negotiated non part provider high dollar claims

Also processed Managed Care/Continued Healthcare/Medicare and ESRD claims

Gained experience with medical claims processing including manual, NEIC, PPO and foreign claims through knowledge of ERISA policies and regulations

Professional Claims Examiner (Aetna/NYLCARE) 1996-1999

Processed high dollar stop loss claims and difficult facility and professional claims

Also processed Managed Care/Continued Healthcare/Medicare and ESRD claims

Provident Health Insurance-Houston, TX 1988-1996

Benefits Specialist/Claims Examiner

Gained knowledge of medical terminology, anatomy, ICD9, procedural, and HFCA coding

Processed complex paper claims, prescription claims, and dental claims and FSA claims

Resolved pending claims, adjustments and refunds

Worked in the eligibility department for reinstating policy and eligibility

Skills PC proficiency includes Microsoft Office including Excel, Word, PowerPoint, Lotus Notes

Verbal and communication skills

Organizational, analytical, and training skills

Experience in supervisory positions

Able to travel

Bilingual in Hindi

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