Denise Wheeler
Lehigh Acres,FL
Summary
Seasoned Benefit Analyst with solid background in employee benefits administration. Possess comprehensive knowledge of health and welfare plans,
Analytical Benefit Analyst recognized for high productivity and efficient task completion. Possess specialized skills in data analysis, benefits administration, and regulatory compliance. Excel at communication, problem-solving, and adaptability, using these soft skills to effectively manage benefits programs and ensure employee satisfaction
Overview
34
34
years of professional experience
Work History
Benefit Analyst III
Anthem, Inc.
Remote
05.2014 - 08.2020
- Successful completion of building individual and employer group products
- Custom group and Medigap plans completed within the time frame given
- Worked on system defects impacting claims processing
- Use of SQL Access for queries, Excel, Facets Product for system defects
- Analysis of the defects was reviewed and corrected
- Testing of the defects was completed to ensure accuracy
- Quality Assurance also reviewed the defects for accuracy
- Managed cross functional projects to ensure timely completion and alignment
- Extensive analysis and research are required for this position
Senior Business Operations Analyst
BCBSMo
04.2005 - 08.2020
- Successful completion of building individual and employer group products
- Custom group and Medigap plans completed within the time frame given
- Worked on system defects impacting claims processing
- Use of SQL Access for queries, Excel, Facets Product for system defects
- Analysis of the defects was reviewed and corrected
- Testing of the defects was completed to ensure accuracy
- Quality Assurance also reviewed the defects for accuracy
- Managed cross functional projects to ensure timely completion and alignment
- Extensive analysis and research are required for this position
Benefit Review Specialist II
Wellpoint, Inc
12.2002 - 08.2020
- Successful completion of building individual and employer group products.
- Custom group and Medigap plans completed within the time frame given.
- Worked on system defects impacting claims processing.
- Use of SQL Access for queries, Excel, Facets Product for system defects.
- Analysis of the defects was reviewed and corrected
- Testing of the defects was completed to ensure accuracy.
- Quality Assurance also reviewed the defects for accuracy
- Managed cross functional projects to ensure timely completion and alignment
- Extensive analysis and research are required for this position
Special Correspondent
BCBSMo
12.1990 - 12.2002
- Lead correspondent handled ERISA Appeals, Department of Insurance inquiries
- Handled member calls and correspondence addressed to the President of BCBSMo
- Attended first and second level Appeals Committee
- Extensive research is required for this position
- Researched all pertinent information, Including a detailed history of the issue
- Medical records and reviews by internal physicians were usually required
- Delivered reporting with 100% accuracy by checking validity of all facts present
- Assisted our Legal Department in cases and conducted thorough reviews of the case
- On one occasion, I was a witness in a case in which I created a summary of the related claims and how they would have paid if benefits were available
- Handled members who came to the office for enrollment, claim filing, claim status, pay bills etc
Customer Service Representative
BCBSMo
05.1986 - 12.1990
- Handled telephone calls from members regarding benefits, claims, request for another review
- Initiated Individual Consideration reviews and physician reviews on behalf of the member regarding claims inquiries
Education
Medical Terminology test -
BCBSMo
04.2005
High School Diploma -
O’Fallon Township High School
05.1981
Skills
- Trizetto Facets
- Microsoft Excel Word
- Microsoft Access (SQL)
- Strong analytical and research abilities
- Medicare Advantage Product
- Group and individual Facets products
Hobbies and Interests
- Research
- Analysis
- Challenges
Status
On Social Security Disability while looking for positions.
Retirementdate
08/01/20
Timeline
Benefit Analyst III
Anthem, Inc.
05.2014 - 08.2020
Senior Business Operations Analyst
BCBSMo
04.2005 - 08.2020
Benefit Review Specialist II
Wellpoint, Inc
12.2002 - 08.2020
Special Correspondent
BCBSMo
12.1990 - 12.2002
Customer Service Representative
BCBSMo
05.1986 - 12.1990
Medical Terminology test -
BCBSMo
High School Diploma -
O’Fallon Township High School
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