Network Service Specialist
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
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
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
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
October 2005 - July 2006
Received and responded to telephone inquires related to appeals, benefits, claim status and eligibility.
Claims Customer Service Representative II
July 2005 - October 2005
Claims Customer Service Representative I
February 2005 - July 2005
Claims Customer Service Representative
JLT Services Corporation
July 2004 - February 2005
IDS Life Insurance of New York
November 2003 - July 2004
Customer Relations Specialist
May 2000 - November 2003