Microsoft Excel
Julie Cool
Edwardsville
Summary
Accomplished Senior Specialist with a proven track record at GEHA, enhancing team performance through expert coaching and mentoring. Skilled in problem-solving and workflow management, I significantly improved operational efficiency. Renowned for excellent communication and organizational skills, I drive business success by optimizing processes and fostering positive vendor relationships.
Overview
28
28
years of professional experience
Work History
Senior Cost Recovery Specialist/Coordinator
GEHA
06.2013 - 12.2024
- Lead team of 10-12 Cost Recovery Specialists
- Cross trained all specialist positions in department to provide optimal support and meet production goals.
- Acted as subject matter expert, answering internal, and external questions and inquiries.
- Established open and professional relationships with team members to achieve quick resolutions for complex and/or escalated issues.
- Responded directly to escalated phone calls and correspondence requesting supervisor/manager intervention
- Health Insurance claims processing, adjustments and workflow process audit
- Recovered overpaid benefits and liaised with clients to provide status updates on accounts and projects.
- Coordinated with 3rd party vendors to provide services while maintaining member confidentiality and verifying all HIPAA, FEHB and OPM guidelines were followed.
- Optimized customer experience by delivering superior services and effectively troubleshooting issues.
- Conducted regular reviews of operations and identified areas for improvement.
- Detected errors and initiated or arranged for corrective action, following through with cognizant parties to verify resolution.
- Participated in meetings and associated events to help define and achieve departmental and/or organizational objectives.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Created detailed spreadsheets using Microsoft Excel from ad-hoc reports and distributed to inform management in support of decision-making.
- Implemented user acceptance testing with focus on documenting defects, identifying bottlenecks and executing test cases.
- Completed pre-implementation testing for new system modifications to assess potential impacts.
- Goal-oriented professional with proven success in applying analytical skills to solve complex problems and overcome challenges. Dedicated to enhancing team performance and driving business success.
Contract Insurance Specialist
Insurance Overload Staffing Systems
01.2012 - 06.2013
- Learned and adapted quickly to new technology and software applications.
- Reviewed and processed Health Insurance claims for benefits.
- Followed up on denials, extensions and other special circumstances.
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
- Contacted client providers and facilities to recover overpaid benefits and resolve disputes
- Managed time efficiently in order to complete all tasks within deadlines.
Health and Welfare Team Lead
Boilermakers National Funds
04.1997 - 07.2011
- Lead team of 12-15 Health and Welfare Fund Specialists
- Acted as subject matter expert, answering internal, and external questions and inquiries.
- Researched and resolved complex or escalated issues.
- Liaised with 3rd party PPO Pricer to provide status updates on accounts and projects.
- UAT, QA Analysis, Process Flow Mapping, development of auto-adjudication matrices
- Health Insurance claims processing and adjustments
- Recovery of overpaid benefits
- Claims Audit, Medical Review and Appeals
- Intermittent Supervisor
Education
No Degree -
Kansas City Kansas Community College
Kansas City, KSSkills
- Excellent communication
- Multitasking
- Problem-solving abilities
- Organizational skills
- Written communication
- Attention to detail
- Workflow management
- Employee training
- Coaching and mentoring
- Conflict resolution
- Process evaluation and enhancement
Accomplishments
- Lead team of 10-12 staff members and 15 Contingent workers.
- Provided detailed reporting to management based on Business Operations Analysis
- Maintained production standards 20% above outstanding metrix with 100% accuracy.
- Developed Job Aids and Desk Level Procedures to streamline processes and increase efficiency and accuracy
- Audited, edited and updated language and formatting for outgoing correspondence in over 100 letters and templates.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Full TimeWork Location
RemoteHybridImportant To Me
Flexible work hoursHealthcare benefitsWork from home optionPaid time offPaid sick leave401k matchStock Options / Equity / Profit Sharing4-day work weekCompany CultureSoftware
Microsoft Word
Macess
Facets
Microsoft Teams
Outlook
Access
Powerpoint
Claimfacts
Workday
Timeline
Senior Cost Recovery Specialist/Coordinator
GEHA
06.2013 - 12.2024
Contract Insurance Specialist
Insurance Overload Staffing Systems
01.2012 - 06.2013
Health and Welfare Team Lead
Boilermakers National Funds
04.1997 - 07.2011
No Degree -
Kansas City Kansas Community College
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