Work Preference
Summary
Overview
Work History
Education
Skills
Timeline
Manager
Open To Work

Jason A. Edwards

Beaverton,OR

Work Preference

Job Search Status

Open to work
Desired start date: 2 weeks notice

Desired Job Title

SupervisorClaims Team Leader

Work Type

Full Time

Location Preference

On-SiteRemoteHybrid
Location: Beaverton, ORPortland, ORHillsboro, ORTualatin, OR
Open to relocation: No

Important To Me

Career advancementWork-life balanceCompany CultureHealthcare benefitsWork from home optionPaid time off401k matchPaid sick leavePersonal development programs

Summary

Detail-oriented Health Insurance Expert specializing in claims processing, training, and customer relationship management. Skilled in adapting to new systems while ensuring accuracy and efficiency. Focused on innovative solutions that drive team performance and enhance service delivery.

Overview

24
24
years of professional experience

Work History

Commercial Claims – Claims TS

Providence Health Plans
02.2016 - Current
  • Reviewed and processed high-dollar claims exceeding $20,000.
  • Addressed Cigna, First Health, First Choice, and CleaHealth claims issues through thorough review.
  • Audited processor work and coached team to improve performance.
  • Executed day-to-day duties with accuracy and efficiency.
  • Proposed solutions that improved team outcomes and effectiveness.
  • Collaborated with diverse coworkers to achieve objectives and resolve product-related issues.
  • Coordinated with provider relations, sales, and customer service to resolve member and provider issues.
  • Trained processors on current procedures and new claims processing systems.
  • Conducted interviews for hiring of potential processors and for in house promotions to the technical specialist role
  • Prioritized and organized tasks to efficiently accomplish service goals.
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
  • Assisted with customer requests and answered questions to improve satisfaction.

BES - Individual Membership, Medicaid

Moda Health
07.2014 - 02.2016
  • Use of Facets system for Individual, Medicaid & Group eligibility and billing
  • Researched and resolved billing, payment, and eligibility issues for Oregon, Washington, and Alaska HIX.
  • Conducted 834 file audit for Oregon Medicaid and reconciled Medicaid groups.
  • Researched and updated individual agent commission data, auditing paid commissions to resolve agent payment disputes.
  • Managed daily operational tasks to ensure smooth workflow.

Membership Ambassador

Regence BlueCross BlueShield of Oregon
Portland, OR
04.2006 - 07.2014
  • Administered facets system for eligibility and group billing, achieving accurate reconciliation audits.
  • Managed association and trust group eligibility and billing administration efficiently.
  • Supported membership administrators in reconciliation processes, ensuring compliance with established procedures.
  • Facilitated communication by answering calls from membership administrators, enhancing collaboration between US and India teams.
  • Trained insurance professionals in India on eligibility entry, maintenance, and policy procedures.
  • Audited ANSI 834 transmissions for accuracy in entry and maintenance.
  • Generated detailed reports using TOAD for membership administrators.

Auditor

Software Solutions Unlimited
Portland, OR
04.2002 - 02.2006
  • Audit incoming EDI transmissions for various clients
  • Verified rates and tariffs to ensure billing accuracy for clients
  • Resolved rate issues stemming from database errors, enhancing data integrity
  • Supported Senior and Associate Auditors in completing audit tasks and responsibilities
  • Responded to incoming phone calls from clients and carriers, addressing inquiries.

Auditor

Software Solutions Unlimited
Portland, OR
04.2002 - 02.2006
  • Audited incoming EDI transmissions for multiple clients, ensuring compliance with industry regulations.
  • Verified rates and tariffs to guarantee billing accuracy.
  • Identified and resolved database errors that impacted the accuracy of rate calculations.
  • Provided support for senior and associate auditors during critical audits.
  • Managed incoming phone calls from clients and carriers to efficiently address inquiries and provide timely solutions.

Education

General Studies - no declared major

Concordia University
Portland, OR
01-1994

High School -

Tigard High School
Tigard, OR
01-1992

High School -

Marshall High School
Portland, OR
01-1990

Skills

  • Claims auditing
  • Claims training
  • Claims reconciliation
  • Customer relationship management
  • Customer management
  • System reconciliation
  • Project coordination
  • Training and coaching
  • Team collaboration
  • Problem solving
  • Communication skills
  • Time management
  • Dispute resolution
  • Claims management software
  • Analytical thinking
  • Regulatory adaptability
  • Multitasking abilities
  • Self-direction

Timeline

Commercial Claims – Claims TS

Providence Health Plans
02.2016 - Current

BES - Individual Membership, Medicaid

Moda Health
07.2014 - 02.2016

Membership Ambassador

Regence BlueCross BlueShield of Oregon
04.2006 - 07.2014

Auditor

Software Solutions Unlimited
04.2002 - 02.2006

Auditor

Software Solutions Unlimited
04.2002 - 02.2006

General Studies - no declared major

Concordia University

High School -

Tigard High School

High School -

Marshall High School

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Jason A. Edwards