Summary
Overview
Work History
Education
Skills
Awards
Languages
Timeline
Generic

Belinda Fillmore

San Antonio,USA

Summary

Care Management Associate with Aetna, specializing in health insurance and claims processing. Demonstrated ability to enhance team performance through targeted training and leadership initiatives. Expertise in policy compliance and problem-solving, ensuring high-quality service delivery while safeguarding confidentiality. Developed training materials that significantly improved staff knowledge and operational efficiency.

Overview

25
25
years of professional experience

Work History

Care Management Associate

Aetna
San Antonio, USA
05.2006 - Current
  • Support comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of health services service.
  • Screens patients to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
  • Maintained privacy and confidentiality of patients in compliance with policies and regulations.
  • Monitored, mentored, and coached associates calls along with handling escalated client calls and performed case/phone audits.
  • Titled as A SME (Subject matter expert) and conducted meetings with the team to discuss new workflows and processes (including training team members).
  • Conducted monthly stat reports on a team for performance discussions, mid-year and end of year reviews.
  • Collaborated with internal departments to find resolutions and conduct further research on customer accounts.
  • Developed and implemented training materials for new hires.
  • Monitored call center metrics to ensure optimal productivity and efficiency.
  • Managed and oversaw a team of 20 customer service representatives.
  • Provided support during high volume periods or when staff was shorthanded.
  • Assisted with recruitment, interviewing, and hiring process for new Customer Service Representatives.
  • Facilitated ongoing training sessions to keep staff updated on product knowledge and industry trends.

Claims Benefits Specialist

Aetna
San Antonio, USA
11.2000 - 05.2006
  • Analyzes and approves routine claims that cannot be auto adjudicated.
  • Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
  • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
  • Ensured prompt payment of approved claims according to company procedures and regulatory requirements.
  • Verified accuracy of submitted claim information by cross-checking with available records.

Education

Diploma -

Oliver Wendell Holmes High School
San Antonio, TX

Skills

  • Health Insurance
  • Quality improvement
  • Policy compliance
  • HIPAA compliance
  • Medical coding
  • Documentation and recordkeeping
  • Verbal and written communication
  • Staff leadership
  • Teamwork and collaboration
  • Claims processing
  • Team management
  • Customer service
  • Performance monitoring
  • Call auditing
  • Problem solving
  • Networking and outreach
  • Healthcare
  • Training and education
  • Team collaboration
  • Telephone etiquette
  • Confidentiality
  • Collaboration and teamwork
  • Patient health information Access
  • Documentation review
  • Administrative support
  • Problem-solving
  • Teamwork
  • Multitasking capacity
  • Prioritizing tasks

Awards

Aetna Way Excellence Award, 2013, For creating and implementing a workflow that reduce the amount of returned determination letters which resulted in cost savings.

Languages

Advanced, English

Timeline

Care Management Associate

Aetna
05.2006 - Current

Claims Benefits Specialist

Aetna
11.2000 - 05.2006

Diploma -

Oliver Wendell Holmes High School

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