Dedicated and meticulous healthcare professional with ability to perform data entry, processing and research experience with high rate of accuracy and efficiency. Excellent interpersonal communication skills with strong attention to detail, and problem solving skills. Builds and maintains collaborative working relationships.
Plexus Management Group, Westwood, MA
June 2016 to present
- Requesting medical records and documentation from facilities
- Sending out corrected medical claims to providers and verifying eligibility for insurance coverage through various means
- Handling and sorting correspondence by scanning documentation into teams share folders
- Document all activity in system and update accounts according to department guidelines
- Office support to Managers and staff as needed
Data Bank, Canton, MA
April 22, 2016 – June 7, 2016
- Preparing files for scanning in a timely manner. Temporary position
Tufts Health Plan Public Plans, Watertown, MA
Appeals and Grievance Specialist
October 2010 through March 2016
- Ensure professional handling of all member appeals and grievances in a timely and efficient manner.
- Utilized broad understanding of all Tufts Health Plan Public Plan products and benefits as well as an understanding of other internal and external constituents about highly escalated issues.
- Provided accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Tufts Health Plan Public Plan members (member appeals and grievances) for all products.
Network Health, Medford, MA
June 2007 to October 2010
- Processed assorted claims for payment or denial. The claim representative must possess broad understanding of all Network Health Public Plan products and benefits as well as an understanding of other internal and external constituents about highly escalated issues.
- Provide accurate coordination, efficient administration and resolution of member claims submitted by Network Health providers for all products.
- Handle the coordination of benefits to check on other insurance members may have before processing claims for Network Health.
John Hancock Financial Services
May 1976 to December 2005
- Respond to various daily requests from distribution channel groups providing service to upscale niche markets including Corporate Owned Life Insurance, Estate Protection, Direct Brokerage Service and M Group Service.
- Handle daily output, priority mail and work tracking, prepared single Life in force illustrations using Hansel application.
- Filed all correspondence for audit trail purposes and handling incoming and outgoing mail in accordance with John Hancock Financial Services compliance policy.
- Prepared/sent out acceptance letters to carriers to ensure timely processing of 1035 exchanges.
- Processed different life insurance changes to policies i.e. changes, beneficiary changes. Life of business changes and cost changes.
Salter School Health Claims Specialist Program
September 2006 to May 2007
- Knowledge of insurance claims processing using the diagnosis and procedure coding ICD9, CPT and HCPCS.
Massachusetts Eye Research and Surgery Institute
Externship: (completed one hundred and eighty-five hours)
Worked on National Provider Identification Number Project, filing
appeals for denied claim payments and electronic claim follow ups for