Experience

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  Scott & White Health Plan

  • Claims Operations Business Analyst

    • Mar 2013 - Present

    •Reviews medical claims for proper payment. •Reviews complaints/grievances, redeterminations/reconsiderations and appeals for regulatory compliance. •Responsible for daily operations of all required functional components of the process, including reporting/audits, interface with other SWHP operational departments, maintenance to policies and procedures according to regulatory standards and duties supporting the goals and objectives of SWHP. •Communicates to the membership the policies, procedures and services of the SWHP, and handles any complaints concerning the Plan by the membership Determines member eligibility based on specific guidelines in order to help maintain the Scott & White Health Plan membership system. •Reviews/research claims for correct payment•Oversees claim processing, investigates billing problems and assists with error resolution.

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  Folkerson Property Management

  • Office Manger

    • Jan 1999 - Jan 2007

    •Successfully handled 500 properties. •Managed commercial, industrial and residential real estate properties for clients.•Executed daily operations of the property management office and its employees.•Reviewed activity of administrative and managerial personnel to ensure smooth communication and adherence to applicable regulations.•Responded to written and telephone requests for security deposit dispersals, owner inquires and tenant request.•Discussed terms for providing management services and drafted agreements stipulating extent of management responsibilities, services to be performed and costs for services.•Prepared lease and rental agreements for lessees and collected specified rents and other sums owed.• Structured and maintained a employee folders, manuals, health benefits, retirement benefits. •Supervised employees, scheduled work hours, resolved conflicts. •Trained and managed employees and achieved significant improvements in their productivity.

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  AAFES

  • Fort Hood, Texas

  • Human Resources Specialist

    • Aug 1990 - Sep 1999
    • Fort Hood, Texas

    •Interviewed job applicants in order to select people meeting employer qualifications.•Reviewed employment applications and evaluated work history, education and training, job skills, compensation needs and other qualifications of applicants.•Reviewed job orders and matched applicants with job requirements.Informed applicants of job duties, compensation, work schedules and working conditions, company and union policies and promotional opportunities.•Performed reference and background checks on applicants.•Served as project manager for the United Way Champaign for three years,•Searched for and recruited applicants for open positions.Scheduled individuals for technical job-related skills training to improve individual work performance.•Participated in resolving labor relations issues.•Successfully handled the incentive awards program and the employee yearly elevations programs.•Assisted in screening applicants for training programs.•Recruited, interviewed and selected employees to fill vacant positions.•Planned and conducted new employee orientation to foster positive attitude toward company goals.•Kept record of insurance coverage, pension plan and personnel transactions, such as hires, promotions, transfers and terminations.•Investigated accidents and prepared reports for insurance carrier.•Conducted wage survey within labor market in order to determine competitive wage rate.•Met with shop stewards and supervisors to resolve grievances.•Perpared separation notices for employees separating with cause.•Conducted exit interviews to determine reasons behind separations.•Represented company at personnel-related hearings and investigations.•Maintained records of hired employee characteristics for governmental reporting purposes.