JILL MULVAUGH-WALDMILLER
Lancaster,NY
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Well-versed in evaluating team performance resolving escalated issues, and developing programs and protocols to enhance productivity. Deep understanding of customer relationship management.
Overview
16
16
years of professional experience
Work History
Claims Research Specialist
Fidelis Care
02.2021 - Current
- .Researched and resolved disputes, billing discrepancies, and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings.
- Handling 10 hospital facilities, 2 outpatient facilities, and 1 homecare provider to review inquiries, emails, appeals, and claims issues.
- Meeting 110% of metrics for emails, appeals, spreadsheets and manually enter in claims.
- Review benefits and authorization request to make sure claims are processing correctly.
- Managed time efficiently in order to complete all tasks within deadlines.
- Cultivated interpersonal skills by building positive relationships with others.
Claims Examiner II
Fidelis Care
03.2020 - 02.2021
- Reviews appeals and complaints; researches any missing or required information.
- Responds to providers, members, or other company departments to process and resolve claim issues.
- Processes all claims eligible or ineligible for payment accurately and, production standards and specifications.
- Determines level of reimbursement based on established criteria, provider contract, plan and employer group provisions, for multiple products.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Consistently met or exceeded performance metrics, demonstrating strong understanding of claims review process and unwavering commitment to achieving positive results for clients.
Medical Office Manager
UBMD General Surgery
05.2019 - 08.2019
- Created welcoming office environment by maintaining clean, organized spaces for staff use.
- Assessed processes and procedures, complying with OSHA, and HIPAA regulations.
- Completed bi-weekly payroll for 5 employees.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
- Maintained strict confidentiality of sensitive patient information, adhering to HIPAA guidelines and safeguarding against potential data breaches.
- Managed supervisor itinerary and appointments and streamlined scheduling procedures.
Senior Quality Consultant
Aetna Insurance Company
08.2018 - 05.2019
- Presented findings from audits and assessments in concise manner for executive review, supporting informed decision-making at highest level.
- Writing contracts, Restates, Flexible Spending contracts, Summary Benefits coverage. and Summary Plan Descriptions.
- Troubleshoot and propose solutions to decrease audit errors
- Provide investigation support to management, document new processes as needed, and cross-train on other responsibilities.
- Recorded, analyzed and distributed statistical information.
- Evaluated interactions between associates and customers to determine areas in need of improvement.
COBRA Client Service Specialist
Lawley Benefits Group
05.2017 - 07.2018
- Implementing new groups, plans, and renewing COBRA plans for 20-30 employer groups.
- Remain up-to-date with current COBRA regulations.
- Working with insurance carriers to enroll, cancel and set up new group plans.
- Responded to customer and employer groups requests via telephone, email, and effectively answered questions and inquiries.
- Entered details such as payments, account information and call logs into Epic system.
- Open enrollment processing, including preparing and processing any communication through COBRA Portal as needed.
Customer Service Supervisor
Nova Healthcare Administrators
01.2014 - 03.2017
- Built highly efficient administrative team through ongoing coaching and professional development opportunities.
- Identified customer service trends to provide recommendations for process and procedural improvements.
- Evaluated individual performance metrics to identify areas of improvement, providing targeted coaching to boost results.
- Conducted regular quality assurance checks on team interactions with customers, ensuring adherence to company standards.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
- Implemented quality assurance measures, leading to increase in first-call resolution rates and overall customer satisfaction scores.
- Completed bi-weekly payroll for 20 employees.
Customer Service Representative
Independent Health & Nove Healthcare Administors
09.2007 - 01.2014
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Utilized as subject-matter expert for customer service representatives.
- Selected to implement new developmental program for Flexible Spending Accounts.
- Maintained uo-to-date product knowledge of Self-Funded Medical Plans, Flexible Spending Accounts, Health Reimbursement Accounts, Pharmacy Benefit Dimensions Plans.
- Provide assistance with training and sign off process for new employees.
- Exceeded performance metrics consistently, earning recognition as top performer within team.
Education
Master of Science - Health Administration
University of Phoenix
Tempe, AZ08.2026
MBA - Business Administration
University of Phoenix
Tempe, AZ08.2026
Bachelor's - Healthcare Administration
University of Phoenix
Phoenix, AZ04.2019
Associate of Science - Medical Records
University of Phoenix
Phoenix, AZ05.2009
Skills
- Team Leadership
- Hiring and Terminations
- Scheduling
- Work Planning and Prioritization
- Healthcare industry understanding
- Follow-up skills
- Medical terminology knowledge
- Microsoft products expertise
- HIPAA Regulations Understanding
- Time management mastery
- Healthcare Compliance Knowledge
- Claims Processing
Additional Information
As a Call Center Supervisor I created a powerpoint presentation for a new mentorship program to help new hires adjust better to the call center atmosphere and processed. Presented this in front of my company's Vice President, Director, Training and development manager, and my own manager.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Far and away the best prize that life offers is the chance to work hard at work worth doing.
Theodore Roosevelt
Timeline
Claims Research Specialist
Fidelis Care
02.2021 - Current
Claims Examiner II
Fidelis Care
03.2020 - 02.2021
Medical Office Manager
UBMD General Surgery
05.2019 - 08.2019
Senior Quality Consultant
Aetna Insurance Company
08.2018 - 05.2019
COBRA Client Service Specialist
Lawley Benefits Group
05.2017 - 07.2018
Customer Service Supervisor
Nova Healthcare Administrators
01.2014 - 03.2017
Customer Service Representative
Independent Health & Nove Healthcare Administors
09.2007 - 01.2014
Master of Science - Health Administration
University of Phoenix
MBA - Business Administration
University of Phoenix
Bachelor's - Healthcare Administration
University of Phoenix
Associate of Science - Medical Records
University of Phoenix
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