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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Woodrow Ave New Albany, IN PHONE NUMBER AVAILABLE EMAIL AVAILABLEProfessional SummarySubrogation Professional 2 for Humana handling PC, Med Mal, WC, and PC subrogation files recouping monies that were paid by Humana when we were not Primary and should have been secondary. Humana Agent Support with Medicare and Medicaid experience at looking at multiple plans and compliance .Subrogation paralegal 5 years negotiating settlements between insurance company and injury lawyer. Experience with investigating identity theft, collecting evidence and preparing reports with exhibits. Preparing legal documents for court. Medicare and Medicaid abuse, fraud, and waste training. Knowledge of Medicare, Medicaid, and Fully insured laws. Medical terminology and CPT code experience.SkillsExperience reading and understanding Contract LanguageInbound / Outbound call center customer service experienceData AnalysisInvestigations in identity theftCPT codingFraud, abuse, waste training in Medicare & MedicaidOffice skills including Excel, Microsoft, Outlook, PowerPointPresentationsPowerful negotiatorExtremely organizedTeam leadershipProcess implementationClient assessment and analysisRisk management processes and analysisTeam liaisonSelf-motivatedStrong verbal communicationConflict resolutionWork HistorySubrogation Professional 2Humana 03/2021 PresentHandling claims that involve legal liability and recovery, where Humana has paid claims as Primary when they should have been billed as Secondary.Researching, investigating, negotiating, and settling subrogation cases following Humana guidelines.Collaborate with other departments, insurance adjusters, attorneys, and members to reach an agreement to settle the case.Reading and understanding Plan Contract Information whether it is Fully Insured, Medicare, Med Supp, or Medicaid.Agent Support Customer ServiceHumana 6/2020- 03/2021Maintaining agent support to assist agents to stay in compliance and be able to sell Humana products. Knowledge of plan details, Medicare, Med Supp, Dental, Vision, Commission, and Medicaid was a necessity for position.Assisted agents with Humana applications using our tools .Trained as Tech Bailout where I could assist with tech issues and remotely access agents PCs to efficiently resolve issues during heavier than normal call times such as during AEP.MarketingSquire Boone Village03/2018 6/2020Working with agents so they could sell our products effectively and efficiently.Collecting data to see trends and apply to our advantage so agents as well as customers were satisfied.Discovering and Implementing more efficient ways to work that benefited the agent and made the process easier for our customers.Presentations using PowerPoint for agents as well as customers based on needs at the time where both the customer and Squire Boone benefitted.Conflict resolution when customers were unsatisfied or agents were disgruntled. Needed to bring both together where both felt heard and appreciated.Emotional intelligence applied every day.Implementations SpecialistSkyBridge Resources 03/2018 PresentWorking on a project for T-Mobile sites to have them in compliance for their safes.DispatcherAlpha Mechanical 12/2014 12/2017dispatch service calls from email or telephone requests from customers to techs in the field. Schedule service based on priority. Make sure tech has everything they need to successfully do their job. I dispatch a large area that covers Indianapolis, IN and north, Western KY to some parts of IL such as Marion, Owensboro area, all of TN and plumbing calls here locally. Administer pricing and set up quotes and proposals and turn them into a job. Conflict resolution whether it was a customer or our tech that was unsatisfied. Logistics was a daily responsibility as well as superior customer service both inhouse and for our customers.Job Recruiter,Integrity Staffing Solutions 10/2014 to 12/2014 Louisville, KYInterview people to place in open jobs. Review resumes and skill set. Administer drug test. Check references.Internet and phone repair techCharter Spectrum , 01/2014 to 08/2014 Louisville, KYAnalyze and repair internet or phone issues. Walk customer through various steps to resolve issue. Customer service. Conflict Resolution.Customer Service Representative,HMS Global Maritime 07/2012 to 07/2013 New Albany, INVerify insurance eligibility for various insurance companies.Investigate Insurance fraudEmergency Dispatcher,Harrison Remc , 10/2007 to 06/2012 Corydon, INHandle all after hours emergencies from disconnects to outages and dispatching linemen and contacting emergency facilities if need be. Investigating identity theftPreparing reports dailySubrogation ParalegalSharps & Associates 04/2001- 05/2007Review medical bills/ claimsNegotiate settlements between insurance and attorney.Perform complaints and answers making sure all forms were filed and correct.Skip tracing.Paralegal by contractSelf employed working for attorneys by contract - 1995-2006Preparing court documents for trial and taking depositionsInvestigationsPreparing evidence and attaching exhibits to cases |
