Daniel Freitas
Summary
Detail-oriented Complex Claims Specialist with proven expertise in claims analysis, complex claims processing, and Multiplan inventory management. Committed to optimizing workflows and enhancing team capabilities through effective communication and cross-training.
Overview
13
13
years of professional experience
Work History
Interplan Complex Claims Specialist
Blue Cross Blue Shield of Massachusetts
Hingham
10.2019 - Current
- Managed inventory addition for groups such as Harvard, City of Boston, and various White Glove accounts while maintaining previous responsibilities.
- Continued responsibility of working and maintaining Multiplan inventory but also exclusive inventory pertaining to the White Glove accounts that require special handling.
- Handling other complex inventory such as Air Ambulance claims and adjustment requests, communicating with the Host Plan and Auth/Ref Team to complete claim adjudication.
- Delivered feedback to management on workflow updates and streamlined ODL conversion into accessible workflows via SharePoint.
- Cross-trained associates on claims processing, enhancing their understanding of unfamiliar claim types.
- Worked closely with analyst teams to create new processes and workflows for complex inventory and Multiplan
Interplan Claims Processor
Blue Cross Blue Shield of Massachusetts
Hingham
09.2013 - 10.2019
- Ability to identify and solve problems and process a high volume of claims.
- Fluent use of NASCO, RTMS, SharePoint, Provider Application, ProviderHub, Blue Squared, MHK, Claim Stop Requests
- Processed High volume of Interplan Claims: DME, High Dollar, IMRT/SBRT/PBRT, Duplicates, COB and Medicare
- Primary processor with responsibility for all Multiplan claims and kept inventory at required levels
- Handled additional Multiplan responsibilities, including processing manual CSRNs and managing the Multiplan mailbox.
- Assisted with job shadowing for associates from other departments looking to expand their knowledge on Multiplan
- Trained associates within the team to support processing for Multiplan and DME
- Assisted with identifying claims edit trends and workflow improvements
Education
High School Diploma -
Avon Middle High School
Avon, MA06-2004
Some College (No Degree) - Hardware and Software/Networking
Bay State School of Technology
Canton, MASkills
- Complex claims processing
- Claims analysis
- NASCO proficiency
- Multiplan inventory management
- Workflow optimization
- Process improvement strategies
- Computer proficiency
- Microsoft SharePoint
- Problem identification
- Attention to detail
- Detail orientation
- Cross-functional collaboration
- Adaptability in processes
- Effective communication
Accomplishments
- 100% Claim Processing Accuracy numerous years
- Numerous Ops Props Awards for clear communication skills, teamwork and claim processing accuracy
Timeline
Interplan Complex Claims Specialist
Blue Cross Blue Shield of Massachusetts
10.2019 - Current
Interplan Claims Processor
Blue Cross Blue Shield of Massachusetts
09.2013 - 10.2019
High School Diploma -
Avon Middle High School
Some College (No Degree) - Hardware and Software/Networking
Bay State School of Technology