Experience

Health Partners Plans

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Training Project Manager

  • Feb 2022 - Present

• Learning And Development Specialist

  • Jun 2017 - Present



Independence Blue Cross

• United States
• Insurance
• 700 & Above Employee

• Learning & Development Specialist

  • Nov 2011 - Present

  - Deliver end to end learning and development activities across claims operations- Support HR team with wider learning activities such as coaching, mentoring and leadership development programs - Maintain content and context of all learning materials, ensuring accuracy and relevance- Work with subject matter experts on designing training content and delivery- Build internal and external relationships to secure required resources for training - Leverage business partners knowledge and expertise to create training tailored to the business areas specific needs

• Business Analyst

  • Dec 2008 - Nov 2011

  Documented and analyze data distributed to internal operational areas to ensure IBC is in compliance with Blue Cross Blue Shield Association (BCBSA) mandates and guidelines Created and spearhead projects for the accuracy and development of departmental policies and proceduresExtracted and maintain Blue Cross and Blue Shield survey dataDeveloped content for and distribute IBC’s quarterly newsletter, Inside IPP, to the institutional provider communityServed as point of contact for IBC’s quarterly enrollment report that is distributed to the BCBSAApproved, reviewed and analyzed all Host Case-Specific-Rate Negotiation requests via Blue Squared ToolServed as primary point of contact/ BlueCard Coordinator for other plans resolving complex BlueCard issues by offering expertise, recommendations or assistance Coordinated and facilitated the 2009 BlueCard East Coast Regional Conference

• Claims Payment Adjuster

  • Mar 2005 - Dec 2008

  Completed claim adjustments while maintaining corporate and departmental standardsProvided responses to technical questions and ensure that all inquiries are accurately documented in the SLIQ databaseInvestigated and determined primacy between multiple payers; also coordinated benefits between multiple payers and calculated provider payment based on fee schedules and pricing information given in the Interplan Teleprocessing Services System (ITS) Reviewed Mental Health benefits in conjunction with creating conferences for Trade Psych patientsAssisted the Inter-Plan Programs Operations (IPPO) Technical Support Staff with resolving claim adjudication errors that may have resulted in a negative impact to IBCFOC’s performance

• Claims Process Analyst

  • Nov 2003 - Mar 2005

  Responsible for the accurate and timely review and adjudication of healthcare claims in OSCAR and MHS systemsMaintained and applied comprehensive knowledge of claims processing and support systemsResearched, reviewed and resolved all claims submitted following the appropriate claims processing guidelines.

• Provider Service Representative

  • Jan 2002 - Nov 2003

  Responded to provider questions regarding claims and benefit issues for the Keystone and AmeriHealth HMO or Personal Choice product lines via telephone inquiriesDocumented providers requests and problems in the SLIQ database Interacted with other departments to resolve provider concern such as plan coverage, member eligibility, provider contracts and fee schedulesExpedited high priority projects such as issuing duplicate Explanation of Benefits statements (EOB’s), constructing refund letters and adjusting written claim request received via faxAssisted providers with status of appeals and offset accounts via the GACH and Valutech payment systems