Results-driven professional eager to offer proven Healthcare and Financial Services industries experience,

including strong talents in Medical Claims Processing, Strategic Analysis / Planning, Quality Assurance, Regulatory Compliance, and Client Relations, toward maximizing an employer s success within a key role.

 

 

         Out-of-the-box thinker who demonstrates knowledge of medical claims processing, financial services, and investment planning, including offering talents in strategically analyzing a high-volume of data to meet and / or exceed objectives.

         Ambitious self-starter who contributes superior attention-to-detail and strong problem-solving skills while working among HMOs, PPOs, POS, and Medicare, and liaising between countless providers in alignment with healthcare goals.

         Conversationally proficient in Spanish and Italian languages; able to clear rigorous background checks.

 

 

Customer Service Representative (Contract Position)

 

         Utilize broad scope of medical industry knowledge and dynamic business acumen toward serving as a forward-thinking Medicare HMO and Medical Supplement Representative, including providing wide-ranging benefits, pharmacy, and plan information to individuals, as well as upholding solid customer service which is instrumental in driving operations success.

 

Quality Assurance Auditor (Contract Position)

 

         Contributed sharp analytical abilities toward performing face-to-face audits, including auditing Customer Service Representatives for Medicare-based quality, handling benefits and pharmacy efforts, and serving as a Medicare back up.

 

Medical Claims Specialist / Customer Service Representative (Contract Position)

 

         Demonstrated comprehensive medical claims processing knowledge, strong customer service, and proven technical proficiencies toward providing claim and eligibility information while handling national accounts among several regions.

         Liaised among HMOs, PPOs, POS, and Medicare to handle contract issues, claims correspondence, and problem resolutions, along with communicating claims status, updates, resolutions, and payments to hundreds of providers daily.

         Facilitated detailed documentation for each account with AIMS, WGS, Imaging, CallCare, Mainframe, and other systems.

         Recognized for job performance as the only employee to receive two consecutive accolades from a special recognition board.

 

Medical Insurance Claims Processor / Customer Service Representative

 

         Applied excellent communication and interpersonal relations talents toward assisting callers and providers with questions regarding health benefits as contracted by the government, along with supporting operations with a third party liability area whereas responsibilities included reviewing, researching, approving, and processing legitimate third party liability claims.

 

Trust & Estate Planning Specialist

 

         Strategically steered trust and estate planning for high net worth clientele within a Wealth Management Division, including preparing and entering all financial and personal data into complex systems; calculating net worth, assets, and diverse other information to create effective estate plans; and assisting attorneys with trust documentation as required.

 

 

 

Retirement Plan Coordinator / Administrative Assistant

 

         Coordinated 401(k) plans within a Retirement Plan Services Division, including working among 15 varying technical systems to extract, process, and reconcile 401(k) payroll data, as well as maintaining large-scale recordkeeping systems.

         Ensured seamless processes and regulatory compliance by assisting a Director of Client Services, three Relationship Managers, and Compliance and Conversion Specialists in drafting correspondence, creating spreadsheets and presentations, updating sales and marketing databases, organizing expense reports, and composing kits for client visits.

 

 

Bachelor of Arts in International Studies, Communications, & Political Science

~ Triple Major, Projected Fall 2011 ~

University of Wisconsin-Madison

 

Microsoft Office Suite • Microsoft FrontPage • Avaya CMS Supervisor • CMS Website • CallCare • WGS

Argus Pharmacy System • Medicare-Specific Systems • IBM Lotus Sametime Connect • PADS • eTalk • Access Online

ORT • WebChannel • Diamond • Mainframe • Macess • Caremark Pharmacy • CCMS • Fulfillment • Lotus Notes • Modems

Epitome • Notepad • QNXT • FileNet • CenterView • Silent Observe • IEX • Blue Square • PeopleSafe • Metavante • TAPS