Experience

Neighborhood Health Plan of Rhode Island

• Insurance
• 300 - 400 Employee

• Senior Claims Adjuster

  • Apr 2020 - Present



MetLife

• United States
• Insurance
• 700 & Above Employee

• Disability Call Center Representative

  • May 2019 - Apr 2022



Aflac

• United States
• Insurance
• 700 & Above Employee

• Aflac Insurance Producer

  • Nov 2018 - Feb 2019



Blue Cross & Blue Shield of Rhode Island

• United States
• Insurance
• 500 - 600 Employee

• Sr. Outsource Analyst

  • Jan 1982 - Nov 2017

  Career Profile Highly organized and trained Claims Specialist with an excellent history of successful claims management and loss minimization. Creative and independent problem-solver who also coordinates well with management and other company employees. Skills • Strong customer service skills, including assessing customer needs, adhering to quality standards, evaluating customer satisfaction, and making the proper adjustments or corrections. Excellent active listening skills and ability to give complete attention during busy times. • Exceptional knowledge of insurance contracts coverages claims management programs and all related medical and legal terminology • Strong grasp of a variety of claim processing rules and guidelines • Outstanding proficiency with Microsoft Office applications such as Word, Visio, PowerPoint and Excel • High problem-solving and organizational skills • Proven ability to self-motivate and work independently • Solid written and oral communication skills Professional Experience Blue Cross and Blue Shield of Rhode Island January 1982 – November 2017 Sr. Claims Outsource Analyst – Oversight of the Federal Employees program to ensure the benefits were properly administered according to the guidelines provided by the Office of Personnel Management • Respond to escalated member claims or enrollment issues • Train customer service staff on new policies and operating systems • Monitor the phones to ensure they were properly staffed to respond to customers in a timely manner Medicare Enrollment Quality Assurance Analyst – Check member enrollment applications to ensure they were processed in compliance with Medicare enrollment guidelines. Policy Research Analyst – responsible for researching and writing medical and administrative policies for new and emerging medications and technology. Analyze the impact to the organization Education Johnson and Wales University Bachelor of Science/Management