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yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000

(xxx-xxx-xxxx •


results-driven professional eager to offer 14+ years of experience in medical claims auditing, processing, and customer service, as well as proven expertise in varied it support, workforce management, call center operations roles, toward maximizing a progressive employer s success.



profile of qualifications


         top performer who demonstrates knowledge of medical claims processing, it support, project management, and team building, including offering talents in analyzing a high-volume of data to meet and / or exceed goals.

         ambitious self-starter who offers superior attention-to-detail and strong troubleshooting skills while working among hmos, ppos, pdp, and medicare, and liaising among providers in alignment with healthcare objectives.

         out-of-the-box thinker and road warrior who is seeking travel contracts as a working supervisor / lead.



contracted job history


customer service representative / lead

broadpath healthcare solutions (tufts health plan medicare preferred), boston, ma             2010 c present


         utilize broad scope of medical industry knowledge and dynamic business acumen toward providing high-quality customer support to medicare aged members on hmo, medicare supplement, and pdp plans, including assisting broadpath staff by delivering comprehensive training on tufts health plan policies and procedures.

         instruct broadpath staff on applications in individual workstations, and provide hardware troubleshooting.


supervisor / project manager

broadpath healthcare solutions (cigna private fee for service), nashville, tn                                    2009 c 2010


         led strategic decision-making regarding policies, procedures, workflow, quality, and staff training, including planning and prioritizing staff workload and ensuring customer service performance metrics are achieved.

         directed top-performing staff against targeted production, quality, and scheduling goals to maximize success.

         managed broadpath contract agents and provided integral guidance regarding cigna policies and procedures.

         performed random silent observe on customer service associates to ensure high-quality call delivery, along with providing one-on-one monthly training / development with team members for continued strong results.

         handled all car pool management, rotation requests, travel expenses, timecards, and hotel / rental car issues.


correspondence coordinator

dell perot systems, inc. (anthem blue cross national accounts), denver, co                                         2008 c 2009


         researched all aspects of production work to set up adjustments and letters to providers, including receiving a high-volume of incoming calls regarding claim status, denials, and / or payments, as well as contributing strong communication skills toward resolving claim disputes and issues and researching internal matters.


cobra job title

kelly services (ceridian benefits services, inc.), st. petersburg, fl                                                                             2008


         liaised between providers and subscribers to promptly handle claim denials and payments for medicaid replacement plans, including providing key benefits information and verification and dispute resolution.



non-contracted job history


supervisor / trainer / claims processor / customer service / claims adjuster

best life c health & life insurance, boise, id                                                                                                         2007 c 2008


         applied solid leadership talents toward directing a solutions-focused 10-member team working directly under the vp of operations at a california-based home office, including managing the start-up of a satellite office in boise, as well as delivering training / development programs to ensure seamless business operations.



resume • page two

(xxx-xxx-xxxx •




non-contracted job history (continued)


supervisor / claims processor & adjuster / customer service (continued)

best life c health & life insurance, boise, id                                                                                                         2007 c 2008


         responded to medical, dental, and vision calls from members, providers, underwriters, and brokers, along with manually and electronically processing and adjusting medical, dental, and vision claims from providers.

         interfaced among corporate office on eligibility issues, worked with ppo networks on pricing and organization of claims information for processing, and contacted providers and insurance companies for additional data.

         communicated with underwriting teams for ltd coverage and benefits to set premiums, along with verifying policies and limitations for pre-existing and ltd coverage.


lead / trainer / tech support help desk

albertson s llc (office team / account temps / volt technologies staffing, boise, id                      2005 c 2007


         contributed sharp analytical abilities toward managing fixed assets and oracle reporting processes for each albertson s store nationwide, including converting data into excel format and supporting equipment set ups.

         served as initial point-of-contact for resolution of diverse technical issues throughout all company grocery or drug stores nationwide, along with troubleshooting, researching, diagnosing, documenting, and resolving issues surrounding windows nt and 2000 professional, ms office, email, internet, and hardware / peripherals.


workforce management specialist / report agent

carlson leisure travel, boise, id                                                                                                                                    2002 c 2006


         optimized organizational efficiency by managing and maintaining statistical data within a large-scale command center, including overseeing daily workforce management supporting 250 nationwide travel agents, as well as coordinating staff development efforts with training, operations, and quality departments.

         supported shift realignment processes, scheduling, and administration of policies; managed account executives financial spreadsheets; and assisted it with hardware set up and troubleshooting of floor issues.


it help desk coordinator / customer service

electronic data systems (eds) hewlett packard, boise, id                                                                              2000 c 2002


         provided telephone assistance to end users on a wide variety of desktop support areas, printers, copiers, and scanners, including serving as initial tier-1 help desk support within a windows / mainframe environment.

         routed and escalated calls using trouble ticket systems to network, database, systems, and security specialists.


claims processor / claims adjuster

boise cascade health insurance, boise, id                                                                                                                  1996 c 2000


         drove operations success by manually and electronically processing and adjusting medical, dental, and vision claims from providers, including assisting programmers with eligibility systems and entering claims data.


additional professional roles held prior to 1996



education & technical summary


executive business administration coursework                                                                                      boise state university

wordpress, php, & sql courses (in progress)                                                                                           web design university


nco school (sergeant)                                                                                                                                       united states air force


microsoft office (word, excel, powerpoint, outlook) • crystal reports • iex • blue pumpkin • oracle • bcbsil

avaya cms supervisor • totalview supervisor webstation • csc • cabs • argus • qnxt • taps • icare • filenet

omd • wgs • as / 400 mainframe • blue square • facets • epitome • sametime • pads • centerview • e-talk

macess • peoplesoft-caremark • fis • ccms • diamond • fulfillment • ibm lotus notes • peoplesoft

microsoft windows 2000 • microsoft windows nt • active recovery • microsoft exchange

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