Nancy Manfre

• Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
• Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
• Organized, planned and documented materials for Medical claims.
• Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
• Used Quick Cap systems to program, set up functions and enter data for claims.
• Developed new claim applications for cross-functioning departments.
• Maintained suspicious claims database and prepared reports for supervisors.
• Followed up with insured individuals regarding premium and deductibles payments.
• Prepared official documents for managers or legal personnel.
• Researched claims and incident information to deliver solutions and resolve problems.
• Consulted police and hospital records when needed.
• Analyzed information gathered by investigation and report findings and recommendations.
• Analyzed information gathered by investigation and reported findings and recommendations.
• Conducted day-to-day administrative tasks to maintain information files and process paperwork.
• Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
• Finalized claim files for insurance claim payment release.
• Ordered medical file information to complete claim files.
• Evaluated original investigation reports and documents to resolve secondary concerns.
• Examined claims forms and other records to determine insurance coverage.
• Maintained claims data in Quick Cap systems.
• Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
• Handled complaints and grievances using negotiating and problem-solving skills.
• Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
• Verified accuracy of claim records to maintain accuracy of records database.
• Handled claim calls from customers and other stakeholders about claim processes.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
• Documented information gathered in field and uploaded data to company database for efficient processing using Quick Cap.
• Incorporated claim objectives to achieve action plans and strategies.
• Paid or denied medical claims based upon established claims processing criteria.
• Processed insurance payments and maintained accurate documentation of payments.
• Monitored and updated claims status in claims processing system.
• Estimated quantifiable characteristics of claim products.
• Identified and resolved discrepancies between patient information and claims data.
• Responded to correspondence from insurance companies.
• Researched and resolved complex medical claims issues to support timely processing.
• Reviewed provider coding information to report services and verify correctness.
• Managed large volume of medical claims on daily basis.
• Used administrative guidelines as resource or to answer questions when processing medical claims.
• Verified patient insurance coverage and benefits for medical claims.
• Followed up on denied claims to verify timely patient payment and resolution.
• Directed claims negotiations within allowable limit of $ amount and supported successful litigations for advanced issues.
• Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.

Send memorandum on issues with claims or pay patients

• Inspected condition of locks, window bars, doors and gates to prevent prisoner escapes.
• Sanctioned regulatory compliance while managing visual inspections, work crew accountability, illegal substance checks and cell assessments.
• Oversaw and maintained custody of 270 inmates in maximum security.
• Maintained safety and security of staff and public by applying defensive techniques and physical restraints.
• Mitigated risks and emergency response delays by monitoring weapon inventory controls.
• Examined incoming and outgoing mail to detect contraband.
• Monitored radio transmissions between staff to respond immediately to directions and emergencies.
• Automated document flow by ensuring log books and medical files were maintained with 100% accuracy.
• Effectively interacted with staff, offenders, visitors and public to maintain security within facility.
• Streamlined operational efficiencies by effectively maintaining daily shift activity logs.
• Received and processed inmates into custody of institution by searching prisoners and taking charge of personal property.
• Conducted pat downs and strip searches of inmates and visitors to prevent contraband from entering facility.

• Maintained safety and security of staff and public by applying defensive techniques and physical restraints.
• Authored incident reports for management on violations and discrepancies.
• Conducted pat downs and strip searches of inmates and visitors to prevent contraband from entering facility.
• Reduced escape attempts, crimes and other hazardous activity through close observation and situational awareness.
• Observed and supervised inmates throughout visits, meal time, recreation, phone calls, and showers.
• Identified needed updates to correctional plans and assigned inmates to appropriate housing.
• Booked new inmates into facility and processed inmates for release.
• Prepared reports to document incidents and violations.
• Responded to inquiries from inmates and other members of public.
• Coordinated with other law enforcement personnel to exchange information.
• Completed intake paperwork, fingerprints, and searches.
• Conducted security checks of inmates and living areas.
• Searched building and grounds, living quarters, and work areas for contraband.
• Observed behavior of residents individually and in groups.
• Established positive working relationships and maintained boundaries with resident offenders.
• Assisted in intake and release of inmates.
• Conducted routine and emergency head counts.
• Assisted in development of procedures and policies to maintain peace and order in facility.
• Investigated and responded to incidents of inmate misconduct.
• Made rounds at specified intervals and conducted head counts and roll calls.
• Prepared, processed and maintained forms, reports, logs, records, and activity journals.

• Cultivated interpersonal skills by building positive relationships with others.
• Proven ability to learn quickly and adapt to new situations.
• Strengthened communication skills through regular interactions with others.
• Ran errands and provided general office support in a professional environment.
• Developed strong communication and organizational skills through working on group projects.
• Participated in team projects, demonstrating an ability to work collaboratively and effectively.
• Excellent communication skills, both verbal and written.
• Demonstrated strong organizational and time management skills while managing multiple projects.
• Exercised leadership capabilities by successfully motivating and inspiring others.
• Adaptable and proficient in learning new concepts quickly and efficiently.
• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Learned and adapted quickly to new technology and software applications.