profile

Albert Hayes

Skills

microsoft works

Experience

Network Service Specialist

CDPHP

January 2011 - October 2011

Analyzed and resolved pending health insurance claims with no provider record match. Corrected provider records with new or updated demographic data. Created non-participating provider records in Facets claim system.

Network Strategy Assistant

CDPHP

September 2010 - December 2010

Identified discrepancies between provider contract and claim system. Resolved escalated claim re-pricing issues related to provider fee schedule.

Provider Service Universal Agent

CDPHP

November 2007 - August 2010

Assisted provider service representatives with benefit and claim questions. Educated providers on the benefits of utilizing online provider web portal. Generated and clarified credit balance reports. Provided support regarding electronic claim submission requirements and error resolution. Responsible for resolution of pended claims and service inquires needing provider outreach. Trained new employees.

Provider Service Floater

CDPHP

July 2006 - November 2007

Added to three or more claim status and eligibility phone queues. Educated providers on company policies and procedures. Processed provider appeals and correspondence to resolution.

Provider Service Representative

CDPHP

October 2005 - July 2006

Received and responded to telephone inquires related to appeals, benefits, claim status and eligibility.

Claims Customer Service Representative II

Value Options

July 2005 - October 2005

Claims Customer Service Representative I

Value Options

February 2005 - July 2005

Claims Customer Service Representative

JLT Services Corporation

July 2004 - February 2005

Service Associate

IDS Life Insurance of New York

November 2003 - July 2004

Customer Relations Specialist

LexisNexis

May 2000 - November 2003

Workplace personality

100+

Company Size

12

Day Length

25+

Team Size

Loud

Noise Level

Formal

Dress Code

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