Process Expert II

• Feb 2017 - Present

Customer Care Representative III, Sr.

• May 1992 - Feb 2017

• Pricing individual consideration codes for FEP Customer Care Representatives• Process Pricing pends, Medical policy, Medical review and Medicare Sequestration pends • Process specialty deferrals, adjustments and reopened claims • Field customer service calls and process Correspondence for members and providers• Handled special inquiries for VA Spine and Liberty Medical • Processed Advanced Benefit Determinations • Documented training manuals and trained in claims, customer service, and refunds, then audited representatives. • Special projects assigned by Operations Experts, Business Analysts, and Technical Business Systems Analyst. Including testing claims to verify process in streamline and Direct, reprocessing claims and assigning ACSR to claims to defer in Direct for individual processing and/or manual pricing. • Worked on projects for Pend Reduction and Automation Team Member• Resource for all associates in Federal Employee Program for multiple functions and Blue Link Documents. • Research claim workflow problems and determine is problems area system related. Present workflow irregularities and solutions to fix workflow to process experts for system fix. • Review Blue Link documents. Present and submit Blue Link updates.