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claims benefit specialist
To obtain a position within client relations and technology repair that would give me the opportunity to demonstrate my outstanding leadership and personable skills.
2434 Willow Oak dr.
Columbia SC 29223 Number Hidden home
Number Hidden cell
Objective To obtain a position within client relations and technology repair that would give me the opportunity to demonstrate my outstanding leadership and personable skills.
Experience 2007- present Aetna Columbia, SC
Claims Benefit Specialist
Analyzes and approves routine claims that cannot be auto adjudicated.
Proofs claims or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements
Utilizes all applicable system functions available ensuring accurate and timely claim processing service
2003- 2007 Blue Cross Blue Shield of South Carolina Columbia, SC
Member Service Representative
Researched and responded to telephone inquiries according to desk procedures
Ensured that contract standards and objectives for telephone timeliness, productivity and quality were met.
Identified incorrectly processed claims and completes the adjustment and reprocessing action according to department guidelines.
Professional Review Analyst
Manage high priority accounts and case managements
Analyze delinquent and closed patient’s accounts
Respond to complex customer service inquiries
Manage the monthly reports to be reviewed by the prime contractors
Review medical records and forward for processing
DRG Grouping and research
Research and process inpatient claims
Correspond with prime contractor
2Number Hidden Grand Strand Center Against Rape Crisis Myrtle Beach, SC
Volunteer / Internship
Mentor victims that have been in a major crisis
Provide victims with helpful information
Assure patients have a safe place to reside after the crisis
2001- 2003 NIKE, INC Myrtle Beach , SC
Assist customers with checkout
Open and close department
Perform normal closing procedures
2005- 2007 Horry Georgetown Technical College Myrtle Beach, SC
Human Services/ Minor Computer Programming
2007 – present Limestone College Gaffney, SC
B. S. Computer Information Management/Web Development
Awards/Accomplishments: Horry-Georgetown Technical College Human Services Club (Club awarded: National Organization Human Services Community Service Award 2005 and Alpha Nu Sigma Award for Community Service and Leadership 2005), Participated in homeless Count 2005 and 2007, Salvation Army Boys and Girls Club, Fostering Hope (Horry County children in foster care).
References Available upon request
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