Jewelene Park
Centerfield,UT
Summary
Accomplished Order of Benefits Examiner at SelectHealth, adept in critical thinking and effective communication, significantly enhanced insurance coverage verification and order dispute resolution. Excelled in teamwork and data verification, maintaining high accuracy and audit scores. Renowned for professionalism and problem-solving abilities, contributing to organizational reputation and supporting caregivers through mentoring.
Overview
13
13
years of professional experience
Work History
Order of Benefits Examiner
SelectHealth
01.2019 - Current
- Examined forms and cases to determine insurance coverage and verify eligibility.
- Updated Facets Order of Benefits with correct order and notified member services when applicable.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts on phones.
- Contributed positively to organizational reputation by consistently demonstrating professionalism, integrity, and expertise in the role of Order of Benefits Examiner.
- Ensured compliance with relevant laws, policies, and procedures in ORBT Examiner role.
- Facilitated information sharing among team members to improve overall understanding of complex order disputes, divorce decree documents and other complexities with insurance companies.
- Maintained confidentiality and security of personal information to protect customer privacy and prevent identity theft.
- Performed routine data entry or document management.
- Analyzed information gathered from recoveries investigations, advised claims processors and reported insurance findings to appropriate departments.
- Served as a subject matter expert on ORBT procedures, maintaining a level 2 title and mentoring colleagues on difficult cases.
Dental Claims Processor
SelectHealth
06.2013 - 01.2019
- Maintained a high level of accuracy in data entry while processing large volumes of dental claims daily.
- Continuously refined personal expertise in dental terminology, procedures, materials, and billing codes to maintain the highest level of accuracy in claims processing.
- Certified in general medical claims and processed general medical claims.
- Maintained strong knowledge of basic medical and dental terminology to better understand services and procedures.
- Modified, updated and manually processed codes for edits in adjustments and coordination of benefits. Processed all specialties and queues in dental claims.
- Checked documentation for accuracy and validity on updated systems.
Member Advocate
SelectHealth
06.2011 - 06.2013
- Improved member satisfaction by promptly addressing inquiries and assistance with finding providers and facilities.
- Handled sensitive member information responsibly, adhering strictly to privacy regulations and guidelines.
- Updated software with provider information and specialties.
- Managed high call volumes while maintaining exceptional service quality and professionalism.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
Education
High School Diploma -
Skyline High School
SLC Skills
- Teamwork/Collaboration
- Critical Thinking
- Accuracy and precision
- Problem-solving abilities
- Customer service
- Data verification
- Multitasking
- Effective communication
- Claims reports and documentation
- Experienced in Facets Knowledge
Timeline
Order of Benefits Examiner
SelectHealth
01.2019 - Current
Dental Claims Processor
SelectHealth
06.2013 - 01.2019
Member Advocate
SelectHealth
06.2011 - 06.2013
High School Diploma -
Skyline High School
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