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Yyyyyy x. yyyyyy

- 5216 Coneflower Dr Ÿ Napervxxxxxxle, XXXXXX xxxxxx ( (xxx-xxx-xxxx *


Operations Management (Insurance)

Qualifications Profxxxxxxe


    Self-assured and results-driven solutions provider and management professional with more than 12 years providing high-performance customer service and operations management support in the insurance and healthcare sectors.

-    Proven competence and dedication in delivering outstanding operational excellence that brought regular incentive pay for meeting production, quality, and timeliness goals each month at Travelers Insurance

-    Detaxxxxxx-oriented, analytical and methodical with critical thinking to adjudicate and resolve insurance policy claims, professional relationship issues, and work concerns even under stress.

    Versatxxxxxxe, flexible, and adaptable with quick learning abxxxxxxities to reach high productivity levels in fast-paced work environments and new or demanding assignments.

    Well-organized with multitasking and prioritization skxxxxxxls that maximize resources to achieve outstanding results.

    Effective interpersonal communication skxxxxxxls that transform workforce diversity into a unified team advantage in achieving shared commitments.


Professional Experience


Bankers Life and Casualty Company

Policy Change Specialist-New Business Health Operations Apr 2012 Present

    Responsible for analyzing, processing, issuing, and reissuing all new business health insurance policies as approved by the Underwriting Department, reconcxxxxxxing and adjusting accounts as needed, and collaborating with Underwriters and agents to ensure policy accuracy and completeness on a daxxxxxxy basis.

    Investigate, analyze and evaluate insurance claims, ensuring compliance with policy terms and guidelines, and recommending approvals or rejections as the case may be.

    Modify and process agent commission and credit/chargebacks for various benefit and plan changes, exchanges, cancellations, member additions, separations, downgrades, upgrades and issue date adjustments.

    Serve as a member of the new AIM Implementation Team for processing claims.


Hallmark Services Corporation BCBS of XXXXXX

Medicare Supplement Policy Processor Mar 2011 Apr 2012

    Served as mentor/coach for new hires and junior staff on policies, procedures, service standards, and guidelines.

    Reviewed and distributed all Medicare reimbursements, processed customer and agent requests such as cancellations, downgrades and upgrades for O65 members, and helped develop the new Medicare/BCBS of Xxxxxx Department.

Jr. Processor/Under 65 Jun 2008 Mar 2011

    Evaluated and resolved large volumes of customer requests, processing, verifying, and distributing refund checks accordingly, and assisting several projects in workflow and process improvements in healthcare service reform.


Travelers Insurance

Premium Audit Processor/Analyst Jun 2005 Nov 2007

    Processed large volumes of multi-line commercial policies, collaborating with Underwriters and Auditors on a daxxxxxxy basis in ensuring proper evaluation, processing, and approvals for insurance applications.

    Served as a Member of the Employee Committee, providing HR support in training new hires and junior staff in processing coverage estimates, policyholder reports and automobxxxxxxe insurance policies.


Education & Credentials


    Business Management/ Speech Communications, COLLEGE OF DUPAGE Glen Ellyn, XXXXXX (1998 2000)


Technical Skxxxxxxls

    Applications: System 80, Trace, TPX, SHARP, TRECS, Bluechip claims software, AIM (Agent Incentive Management System), BSPN, & AWD

    Productivity Tools: MS Office ( Word, Excel, & PowerPoint), Lotus Notes, & Adobe Acrobat

Professional Training & Certifications

    Certified Web Designer in HTLM 4.0 & Java Script, First Institute of Technology (2000 2001)



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