Louis Joseph
North Tonawanda,NY
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
16
16
years of professional experience
Work History
Blue Card Senior Claims Processor
Highmark BlueCross BlueShield of WNY
Buffalo, NY
10.2022 - Current
- Collaborated with management on urgent and aged claims processing.
- Engaged with different teams to tackle member and provider claim problems.
- Utilized BlueSquared to provide accurate updates on claim status for Blues Plans.
- Organized and conducted training round tables to support newly trained processors.
- Test and implement new procedures for streamlined operations.
- Proficient in Oscar, OCWA, INSINQ, Cleanup Tracker,Arrow, BlueSquared, FES,BlueMagic,NCompass and Microsoft Sharepoint
- Regularly analyzed and adjusted Bluecard reports.
- Foster an upbeat environment for enhanced team spirit.
- Reviewed and processed claims to ensure accuracy and compliance with applicable regulations.
- Detected inconsistencies in claim processing, and filed tickets with the designated department.
- Assisted in developing new policies and procedures related to claim processing operations.
- Communicated effectively with team members across multiple departments within the organization.
- Coordinated benefits with medical insurance plans and Medicare providers.
- Provided customized guidance tailored to specific needs.
Blue Card Claims Processor
BlueCross BlueShield of WNY
Buffalo, NY
09.2018 - 10.2022
- Processing claims while meeting quality and productivity standards
- Notifying management of errors in system or desk levels while working closely to resolve issues
- Current member of the desk level team, where I help test and give feedback on new desk levels before they are published
- Assist management with urgent adjustment emails from BlueCard service
- Proficient in Pega, Facets and Claims Admin.
Blue Card Representative Coordinator
BlueCross BlueShield of WNY
Buffalo, NY
10.2015 - 09.2018
- Aided providers in handling cases involving out-of-region Blues Plan members.
- Addressed and rectified provider payment discrepancies.
- Provided support to Kaleida facilities in resolving claim submission errors.
- Informed members about the Away from Home Care benefit eligibility.
- Handled inquiries by members and providers on behalf of FEP.
- Executed tasks such as creating profiles and resetting passwords for Medicare members.
- Experienced in BlueSquare, Streamline, and BlueGuest.
- Experienced with FepDirect.
Telephone Banking Specialist
M&T
Amherst, NY
10.2014 - 09.2015
- Serving as the primary answer line to the telephone banking service representatives
- Mentored and coached employees who were new to the company and department
- Assisting customers that are not satisfied with our primary service level
- Handling intricate customer requests and various tasks
- Adhering to changing standards and procedures
- Implementing new systems and new products via pilot programs
- Complex account review while tracking and filing complaint status
Telephone Banking Service Representative
M&T
Amherst, NY
07.2013 - 10.2014
- Assisting customers with various requests including transfers, balancing accounts, and address changes
- Placing orders for account products such as debit cards, credit cards or check books
- Knowledge of Government mandated banking laws and standards
- Assisting customers with the most cost-effective solution for their needs
- Navigating and through multiple systems at once and communicating with other departments to make sure all tasks are complete.
Dispatcher
Intertech Digital
Lockport, NY
09.2008 - 07.2013
- Schedule dispatch technicians’ appointments and routes
- Verifying that all technicians have received schedules and assign any open jobs to technicians
- Kept accurate record of technicians’ jobs that have been completed so that new jobs are assigned in a timely fashion
- Assisted in company warehouse when needed
Education
School Regents Diploma -
Lockport High School
01.2009
Two Year Building Trades Certification -
Orleans Career and Technical Education Center
01.2009
Skills
- Self-motivated, confident working without supervision
- Positive influence on team morale
- Understanding and positively reacting to changes in business
- Problem-Solving
- Customer Service
- Verbal and Written Communication
- Data Entry
- Active Listening
- Critical Thinking
- Time Management
- Pattern Analysis Skill
- Meticulous Attention to Detail
Timeline
Blue Card Senior Claims Processor
Highmark BlueCross BlueShield of WNY
10.2022 - Current
Blue Card Claims Processor
BlueCross BlueShield of WNY
09.2018 - 10.2022
Blue Card Representative Coordinator
BlueCross BlueShield of WNY
10.2015 - 09.2018
Telephone Banking Specialist
M&T
10.2014 - 09.2015
Telephone Banking Service Representative
M&T
07.2013 - 10.2014
Dispatcher
Intertech Digital
09.2008 - 07.2013
School Regents Diploma -
Lockport High School
Two Year Building Trades Certification -
Orleans Career and Technical Education Center
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