Years of Health Insurance experience
Jacqueline Bednarsky
Conroe,TX
Summary
Most recently worked as a diligent and reliable Data Administration Coordinator with strong abilities in performance & quality. I offer analytical claims and customer service experience. I am highly organized, proactive, and punctual with a team-oriented mentality, while still able to work independently. Employed by the same company for 23 years through multiple acquisitions and met or exceeded expectations in quality and productivity in all positions.
Overview
24
24
Work History
Coordinator, Data Administration
Aetna/CVS Health Corp.
Houston, TX
09.2007 - 08.2023
- Facilitated communication between different departments such as provider or enrollment in order to resolve issues quickly when working Holds and Routes list ensuring TAT is met, maintained Backlog Aged Claims Follow-up list in conjunction with this task
- Reviewed locked claims list & submitted help desk tickets on applicable claims
- Submitted reports such as Conduent IIO Production Totals, OBC Mail Merge
- Reviewed & worked multiple boxes in Rumba such as EC1, EC2, EC3, PC1, ECN, EP1-involved tasks such as researching claims history on newborn claims for possible multiple births, submitting requests for newborn adds, researching provider address selection issues
- Reviewed Coventry Electronic Correspondence Handling System worktasks to ensure claims/correspondence are routed to the correct department in order to meet TAT
- Composed OBC/Member not found letters when applicable
- Volunteered for special projects for other departments & assist the Triage department regularly in routing ECHS worktasks
- Previously worked Coventry fatal edits/error correct before their termination, mentor/train new employees on this task
Service Operations Specialist, Provider Svcs.
Coventry Health Care
Houston, TX
03.2006 - 08.2007
- Add and update provider files
- Ensured quality assurance processes were followed in order to maintain high standards for services provided.
Stop Loss Coordinator
Coventry Health Care
Houston, TX
09.2005 - 02.2006
- Submit Stop Loss claims, Specific and Aggregate plans
- Collaborate with other departments to successfully meet TAT
Senior Claims Benefit Specialist
Coventry Health Care
Houston, TX
09.2003 - 08.2005
- Review and process medical, dental, Medicare claims
- Given high dollar claim clearance due to quality standard excellence
Customer Service Representative
Coventry Health Care
Houston, TX
02.2002 - 08.2003
- Receive inbound calls from providers and members regarding benefits and explanation of of claims payment
- Make outbound calls to providers and members to follow up and resolve issues
- Assist members in scheduling appointments and PPO network selection of providers
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Escalated customer concerns, issues and requirements to supervisors for immediate rectification.
- Maintained or exceeded quality and production standards
Claims Benefit Specialist
Coventry Health Care
Houston, TX
01.2000 - 01.2002
- Reviewed and processed medical, dental, & Medicare claims for accuracy, completeness and compliance with company policies.
Education
High School Diploma -
Klein Forest High School
Houston, TX05.1984
Skills
- Problem Solving Abilities
- Research Ability
- Customer Relations
- Employee Coaching
- Organizational Strengths
- Positive, High-energy attitude
- Flexible and Adaptable
- Cross-functional collaboration
Additional Information
- Received a bonus for identifying a fraudulent provider while in the claims department
Award
· Received an “Angels Among Us” award due to a customer compliment with regards to an inconsolable, potentially self-destructive member while in the Customer Service Department
· Received a bonus for helping to identify a fraudulent provider while in the Claims Department
· Received multiple bonuses for claim quality/production while in the Claims department and several on the spot awards for quality and production while in Customer Service
Timeline
Coordinator, Data Administration
Aetna/CVS Health Corp.
09.2007 - 08.2023
Service Operations Specialist, Provider Svcs.
Coventry Health Care
03.2006 - 08.2007
Stop Loss Coordinator
Coventry Health Care
09.2005 - 02.2006
Senior Claims Benefit Specialist
Coventry Health Care
09.2003 - 08.2005
Customer Service Representative
Coventry Health Care
02.2002 - 08.2003
Claims Benefit Specialist
Coventry Health Care
01.2000 - 01.2002
High School Diploma -
Klein Forest High School
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