Hannie Santana
Niskayuna,NY
Summary
Detail-oriented administrative and insurance professional with over 20 years of experience reviewing claims documentation, insurance records, and compliance-sensitive materials in highly regulated environments. Demonstrated ability to analyze policies, interpret benefit provisions, ensure adherence to statutory requirements, and maintain accurate case records. Strong background in documentation review, regulatory compliance, stakeholder communication, and case tracking. Experienced in handling high-volume workloads while maintaining quality and confidentiality standards.
Overview
31
31
years of professional experience
Work History
Customer Service Representative – Federal Employee Program
Anthem, Inc.
Albany, NY
05.2009 - Current
- Review and analyze member and provider inquiries related to insurance benefits, eligibility, and claims determinations.
- Examine claim documentation and supporting materials for accuracy, completeness, and compliance with plan provisions and applicable federal regulations.
- Interpret insurance policies, benefit provisions, and coverage limitations to explain determinations clearly and accurately.
- Enter, update, and maintain detailed case records and notes within internal claims systems.
- Communicate with members, providers, and internal departments to obtain additional documentation and resolve discrepancies.
- Ensure all activities comply with federal regulations, privacy standards (HIPAA), and internal procedures.
- Manage high-volume caseloads while meeting established productivity and quality benchmarks.
- Relevant Skills Applied: Claims analysis | Documentation review | Regulatory compliance | Case tracking | Confidential records management
Manager
Liberty Tax Service
Rotterdam, NY
01.2009 - 04.2009
- Reviewed financial documentation for accuracy and completeness.
- Ensured compliance with applicable tax regulations and internal procedures.
- Maintained strict confidentiality of client records.
Client Specialist
AON Corporation
New York, NY
11.2003 - 04.2006
- Supported large commercial insurance accounts through policy review and claims coordination.
- Reviewed documentation for completeness and compliance with contractual requirements.
- Maintained organized electronic and hard-copy records.
Account Manager
Willis of New York
New York, NY
08.1997 - 04.2003
- Reviewed insurance policies, endorsements, and certificates to ensure contractual and statutory compliance.
- Assisted with claims reporting and monitored carrier follow-up.
- Maintained comprehensive account and claims documentation.
- Served as primary client contact for coverage and claims inquiries.
Insurance Coordinator
Mount Sinai Medical Center
New York, NY
11.1995 - 08.1997
- Administered medical malpractice and excess liability insurance programs.
- Reviewed physician documentation and verified credentials for compliance with institutional and insurer requirements.
- Prepared and maintained claims profiles and medical documentation summaries.
- Coordinated with insurers, physicians, and risk management staff regarding coverage and claims matters.
- Relevant Skills Applied: Medical documentation review | Compliance verification | Records management | Interdepartmental coordination
OCIP Program Administrator
Willis Corroon Construction Services
New Hyde Park, NY
07.1995 - 10.1995
- Administered Owner Controlled Insurance Programs (OCIP) for construction projects.
- Processed contractor enrollment and claims documentation.
- Ensured compliance with insurance and safety requirements.
Education
Master of Public Administration (MPA) - Emergency & Disaster Management
Metropolitan College of New York
01-2006
Bachelor of Arts - Political Science
Fordham University
Bronx, NY01-2003
Paralegal Studies Certificate - undefined
Baruch College
New York, NY01-1981
Skills
- Claims and documentation review
- Regulatory and statutory compliance
- Policy and benefit interpretation
- Records management and case tracking
- Data entry and system documentation
- Customer and provider communication
- Confidential information handling
- Analytical review and problem resolution
TARGET POSITION
Insurance Fund Services Specialist 1 / Trainee 1 / Trainee 2 (NY HELPS)
Timeline
Customer Service Representative – Federal Employee Program
Anthem, Inc.
05.2009 - Current
Manager
Liberty Tax Service
01.2009 - 04.2009
Client Specialist
AON Corporation
11.2003 - 04.2006
Account Manager
Willis of New York
08.1997 - 04.2003
Insurance Coordinator
Mount Sinai Medical Center
11.1995 - 08.1997
OCIP Program Administrator
Willis Corroon Construction Services
07.1995 - 10.1995
Bachelor of Arts - Political Science
Fordham University
Paralegal Studies Certificate - undefined
Baruch College
Master of Public Administration (MPA) - Emergency & Disaster Management
Metropolitan College of New York