Jill Bruner

• Claims processing and auditing. worked through member access issues, negotiations, and settlements. Ensure policies, procedures and health plans are executed correctly, provided exceptional Customer Service by answering incoming and outgoing phone calls. Established relationships with employer groups, members, vendors, brokers, and internal staff.

• Answered high volume of inbound calls from members and dental offices and provided accurate information about dental insurance benefits and claims. Also, assisted with claim processing procedures and researched and resolved any issues related to the inquiry and provided a follow-up response to either the member or the dental office.
• Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
• Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.

Bookkeeping, entering accounts and invoice information, organizing files to make sure everything is up to date and paid.

• Created and updated records and files to maintain document compliance.
• Conducted research to assist with routine tasks and special projects.
• Provided clerical support to company employees by copying, faxing, and filing documents.

• Random Claim audits to make sure claims were processed and paid correctly for each policy and plan. Also, customer service call audits and monitoring the quality of customer service provided. Ensuring adherence to the policies and procedures and reviewed daily claim edits before they were paid. Lastly, I was the stop loss coordinator and filed stop loss claims that exceeded. Initially I started with the company being a dental claim examiner and the last 8 years, I was a claim auditor.
• Planned audits and audit activities to allocate necessary resources and determine consistency of plans with audit objectives.
• Followed established auditing processes to meet internal and regulatory requirements.