Previously worked for BCBS as Operation Expert

TONI FRAIN

**** *** ******, ***********, ** *****

608-***-****

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

CAREER SUMMARY

Ten years with Customer Service experience, four of these last years in a Team Lead position, including proficiency with Microsoft Office, filing, keyboarding, editing and proofreading and customer relations. Have outstanding flexibility in adapting to change.

PROFESSIONAL SUMMARY

2008 to present Anthem (BlueCross Blue Shield) Platteville, WI

Claims Operation Expert

 Superior oral, written and interpersonal communication skills

 Insure excellent customer relations

 Demonstrate ability to interact professionally with team and customers

 Self-starter

 Develop and maintain a high priority of teamwork

 Provide technical direction, guidance and resources to claims, enrollment and billing or membership associates on day-to-day basis

 Assist associates by answering day-to-day technical questions

 Provide operational training

 Review and maintains records of service level, quality, accuracy and productivity

 Review department policy and procedure manuals for accuracy

 Handle complex case research and resolution

 Work without significant guidance

2006 – 2008 Anthem (BlueCross Blue Shield) Platteville, WI

Recovery Specialist II/Operation Expert

 Responsible for pursuing overpayments or reimbursement from other parties who may be liable for payment of claims

 Handle more complex issues such as auditing and adjusting claims, COB, Medicare, Worker’s Compensation or subrogation

 Determine reason for overpayment or other party liability

 Issue refund request letters or notice letters

 Responds to rebuttals and correspondence with involved parties

 Monitor inventory to ensure workflow remains uninterrupted

 Provide operation training

 Assist associates by answering day-to-day technical questions

 Review and maintains records of service level, quality, accuracy and productivity

 Work without significant guidance

2005 – 2006 Anthem (BlueCross Blue Shield) Platteville, WI

Recovery Specialist I

 Responsible for handling overpayments or reimbursement from other parties who may be liable for payment of claims

 Determine and calculate amount of overpayment

 Issue refund request letters and notice letters

 Process voluntary refunds, adjust claims based on refund received

 Work with little or no supervision

2000 – 2005 Anthem (BlueCross Blue Shield) Platteville, WI

Claims Adjustor IIII

 Process and/or adjust health claims in accordance with claims policies and procedures

 Participate in workflow projects

 Respond to telephone and written inquiries and initiate steps to assist callers regarding issues regarding benefits, provider contracts and adjudication of claims

 Work with little or no supervision

1999 – 2000 Anthem (BlueCross Blue Shield) Platteville, WI

Claims Representative I

 Process health claims in accordance with claims policies and procedures

 Research and analyze claim issues

EDUCATION

1995-1997 Western Wisconsin Technical College La Crosse, WI

Associate’s Degree

 Successfully completed all coursework required for an Associate’s degree.

Contact this candidate