Experience

Innovative Telecom Solutions

• United States
• Telecommunications
• 1 - 100 Employee

• Office Administrator

  • 2015 - Present



Leave of Absence

• Full-time Caregiver

  • 2013 - 2015

  Provided round-the-clock care for terminally ill family members including medication management, assistance with daily living activities to include feeding, bathing, and coordinating in-home therapies and services with Bristol Hospice. Provided round-the-clock care for terminally ill family members including medication management, assistance with daily living activities to include feeding, bathing, and coordinating in-home therapies and services with Bristol Hospice.



Blue Sheild Of California

• United States
• Insurance
• 1 - 100 Employee

• Senior Medical Underwriter

  • 2005 - 2013

  Senior lead and mentor in Underwriting processes, procedures, and protocol to meet daily production goals of team. Assessed an directed team in inventory management and reassigned or adjusted schedules as needed. Reviewed attending physician statements, medical records and made appropriate decisions based on medical histories with defined guidelines. Developed daily reports from a variety of in house programs and worked with cross function teams on special projects. Participated in team meetings, presentations and sales seminars. Resolved elevated issues and aided management in improving processes through identifying loopholes. Provided appropriate recommendations for process improvement and followed through with implementation. Show less



Blue Shield of California

• United States
• Insurance
• 700 & Above Employee

• Broker Services/ Group Eligibility Liaison

  • 1999 - 2005

  Gathered and assessed customer specific data that included financials, small group and employee demographics, and past claim history to identify degree of risk, appropriate benefits, and rates. Processed requests for quotes, benefit plan design features, and financial alternatives for complex insured cases. Communicated and negotiated with sales reps, brokers, and staff on new and renewal business. Approved rates in sales requests, updated tracking databases, and tested ad hoc statistical reports as needed. Show less



N/A

• Beverage Manufacturing
• 200 - 300 Employee

• Provider Credential Specialist/ Internal Audit

  • 1997 - 1999

  Provider Credential Specialist: Captured physician information, degrees, residency, licenses and references for national physician network complying with state bylaws. Worked directly with medical review committee and served as team point person working with associate negotiators to contract providers. Internal Audit: Provided support to Network Operations by tracking, maintaining, auditing and reporting for process integrity. Provider Credential Specialist: Captured physician information, degrees, residency, licenses and references for national physician network complying with state bylaws. Worked directly with medical review committee and served as team point person working with associate negotiators to contract providers. Internal Audit: Provided support to Network Operations by tracking, maintaining, auditing and reporting for process integrity.



VSP Vision Care

• United States
• Insurance
• 700 & Above Employee

• Claims Processor

  • 1996 - 1997

  Medical claims processing using HICFA billing procedures with appropriate CPT/ICD codes. Medical claims processing using HICFA billing procedures with appropriate CPT/ICD codes.



Foundation Health and Cal Comp

• Rancho Cordova, California

• Premium Accounting Analyst

  • 1994 - 1996

  Daily reconciliation of group billings, individual and group enrolment for health and dental plans. January of 1995 transferred to Cal Comp (Subsidiary of Foundation Health) to Direct Collections Unit. Responsible for workers' compensation insurance premium; approximately $50 million book of business. Resolved billing disputes and accounts reconciled and monitored payments. Worked directly with agents, producers and insured to collect delinquent payments to collect delinquent payment. Daily reconciliation of group billings, individual and group enrolment for health and dental plans. January of 1995 transferred to Cal Comp (Subsidiary of Foundation Health) to Direct Collections Unit. Responsible for workers' compensation insurance premium; approximately $50 million book of business. Resolved billing disputes and accounts reconciled and monitored payments. Worked directly with agents, producers and insured to collect delinquent payments to collect delinquent payment.