Mary Fullen
Albany,OR
Summary
Highly organized and detail-oriented professional with strong work ethic and dedication to achieving goals. Skilled at developing and maintaining documentation systems, managing calendars and preparing reports. Knowledgeable in project management principles, business processes and customer service best practices.
Overview
27
27
years of professional experience
Work History
Subrogation Coordinator
Samaritan Health Plans
07.2016 - Current
- Entered data, generated reports, and produced tracking documents.
- Tracked records, filed documents and maintained communication between clients to manage office activities.
- Participated in workshops and in-service meetings to enhance personal growth and professional development.
- Used job-related software to draft and finalize written correspondence and documentation.
- Collected and analyzed business data from various departments to prepare reports and presentations for management.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Delegated tasks to administrative support staff to organize and improve office efficiency.
- Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
- Kept high average of performance evaluations.
- Coached employees through day-to-day work and complex problems.
- Gathered and organized materials to support operations.
- Set priorities and problem-solved workflow issues to maintain rapport with customers and managers.
Subrogation Specialist
Regence Blue Cross Blue Shield
03.2007 - 07.2016
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Followed up with customers on unresolved issues.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
- Conducted full claim investigations and reported updates and legal actions.
- Provided advice to customers regarding claims, rights and insurance processes to prevent disputes.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Negotiated with other involved parties to arrange settlements for maximum results.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
- Collaborated with legal counsel to make organizational claims decisions aligning with governing laws.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
Claims Representative
Farmers Insurance Exchange
02.1996 - 02.2016
- Analyzed and addressed escalated claims to resolve issues quickly.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Updated claims system to track claim status and provide relevant information to other department.
- Maintained accurate and up-to-date records of claim information for future reference.
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
- Interviewed policyholders to verify information and obtain additional details.
- Investigated accidents or incidents to determine cause and extent of damages.
- Prepared and presented detailed reports to management on claims issues to aid in decision making.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Maintained confidentiality of patient finances, records, and health statuses.
- Calculated adjustments, premiums and refunds.
- Posted payments to accounts and maintained records.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Determined appropriateness of payers to protect organization and minimize risk.
- Processed and recorded new policies and claims.
Customer Service Ambassador (Lead)
Regence Blue Cross Blue Shield
02.2006 - 03.2007
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Followed up with customers on unresolved issues.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
- Resolved customer complaints while prioritizing customer satisfaction and loyalty.
- Took ownership of customer issues and followed problems through to resolution.
- Trained and regularly mentored associates on performance-oriented strategies and customer service techniques.
- Followed through with client requests to resolve problems.
- Kept accurate records to document customer service actions and discussions.
- Researched and corrected customer concerns to promote company loyalty.
- Created customer support strategies to increase customer retention.
Education
No Degree - Business / Accounting
Portland Community College
Portland, ORNo Degree - Business Administration And Management
Linn Benton Community College
Albany OrSkills
- Microsoft Outlook
- Customer Service
- Best Practice Implementation
- Document Control
- Microsoft Windows
- Medical Terminology
- Microsoft Access
- File and Data Retrieval Systems
- Microsoft Internet Explorer
- Microsoft Word
- SAP Crystal Reports
- Medical Billing
- Adobe Systems Adobe Acrobat
- Judgment and Decision-Making
- Social Perceptiveness
- Problem Resolution
- Coordinating with Supervisors
- Correspondence and Reports
- Work Planning and Prioritization
- Discretion and Confidentiality
- Reading Comprehension
- Time Management
- Oracle PeopleSoft
- Deliverables Coordination
- Presenting Ideas and Plans
- Verbal and Written Communication
- Insurance Verification
- Requirements Writing
- Citrix
- Negotiation
- YouTube
- Instructing
- Coordination
- Writing
Timeline
Subrogation Coordinator
Samaritan Health Plans
07.2016 - Current
Subrogation Specialist
Regence Blue Cross Blue Shield
03.2007 - 07.2016
Customer Service Ambassador (Lead)
Regence Blue Cross Blue Shield
02.2006 - 03.2007
Claims Representative
Farmers Insurance Exchange
02.1996 - 02.2016
No Degree - Business / Accounting
Portland Community College
No Degree - Business Administration And Management
Linn Benton Community College
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