Connie Odle

Review files from state/federal exchanges for accurate information, make corrections to system when needed. Review subsidy information make any updates to system. Reconcile subsidy payments. Special projects as assigned by management including back up to Operation Expert. Train all new associates to area.

Verify the accuracy of member application with medical records after member was approved by underwriting and given premium based on application. Prepare case for Sr. Underwriter.

Review applications for possible omissions that could result in higher rating or rescission of coverage. Review providers for possible claims abuse. Work with law enforcement and state Department of Insurance on cases.

Multiple positions throughout the claims area that included processing easy claims into the system. I was Team Lead for a short period of time and I helped other processor with questions and to try to meed production and quality standards. Worked as a higher level processor on claims that did not go through the system on first pass. I also worked on Coordination of Benefits with primary and secondary insurance. We determined who was primary/secondary and processed claims accordingly with the other carrier EOB.