Pamela Lawrence-Hardy
Indianapolis,IN
Summary
Personable business professional bringing successful 40-year career in medical insurance roles at this Corporation. Integrity driven, well-qualified and familiar with skills and abilities needed to succeed. Ready to leverage training and experience to take on new professional challenges.
Overview
27
27
years of professional experience
Work History
Sales Assistant I
Anthem
01.2020 - Current
- Types, files, faxes, provides phone support and processes mail
- Prepares and logs proposals
- Maintains supplies
- Researches and resolves routine sales, claims and benefit issues
- Assembles and distributes open enrollment packets
- Gathers, inputs, and tracks sales data
- Generates sales reports
- Reviews incoming request for proposals from Sales and/or Brokers for eligibility and participation requirements
- Verifies information pertaining to reports; prepares data and maintains files, orders supplies, coordinates meetings.
Claims Examiner II
Anthem
10.2017 - Current
- Able to handle more complex claims (Facets)
- Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, and healthcare terminology
- Excellent knowledge of the various operations of the organization, products, and services
- Reviews, analyzes and processes claims/policies related to events to determine extent of company’s liability and entitlement
- Research and analyze claims issues
- Responds to inquiries.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
Caregiver
Self Employed
01.2012 - 01.2016
- Caregiver for elderly Mother.
Benefit Analyst
Jawood/Genpact-Nasco
08.2013 - 03.2014
- Remediated ICD-10 coding in the benefit file; updated files from ICD9 to ICD10
- Made updates to the Benefit File
- NPS claims processing
- Testing
- Read customer documentation such as NAEGs, to clarify business coding requirements for benefit coding
- Performs product validation activities including test planning, test development, issue/defect triage and test execution by performing a variety of tests on the NPS code to ensure claims processing according to specifications
- Ability to work independently
- WAH/Telecommute Worker.
Benefit Analyst Consultant/Benefit Analyst
Wellpoint/Anthem - Indianapolis, IN
02.1997 - 05.2012
- Claims processing (EEC, FDE, HIQK)
- Working knowledge, understanding of medical terminology
- Working knowledge and usage of CPT4, HCPCS, ICD9 coding practices
- Wrote CSR's
- Tested/audited coding updates/changes to insure proper processing
- Read and Understood Benefit File
- Worked with internal and external customers documentation, including Checklists, Benefit Plan Designs, NAEGS
- Support Operational area, researching and answering system problems
- Built coding grids for the benefit coder
- Analyzed issues via Clearquest and problem logs
- Attended Implementation Conference calls
- Experience with OBN (Online Benefit Narrative)
- SME for Benefit Coding
- Identified operational efficiencies to enhance and streamline work flows
- Implemented benefits for new and existing National Groups
- Excellent written and communication skills
- Responsible for 25+ National Accounts in this capacity
- Knowledge of Nasco, MSWord, Office 97, Lotus database, Lotus Notes mail, Excel, CICS, and Windows
- WAH/Telecommute Worker.
Education
Some College (No Degree) - Business Administration
Indiana Institute of Technology - Indianapolis, IN, US
Indianapolis, INHigh School Diploma - General Studies
George Washington High School - Indianapolis, IN, US
Indianapolis, IN01.1982
Skills
- Previous jobs include: FDE, EEC, Customer Service, Account Service Representative, Total Processor, Benefit Analyst I, Benefit Analyst II, Implementation Coordinator and Benefit Analyst Consultant These jobs required excellent communication skills, both to the internal and external customer
- Business Process Improvement
- Workflow Analysis
- User Acceptance Testing
- Microsoft Office Suite
- Adaptability
- Time Management
- Problem Solving
- Business Analysis
References
Upon request
Timeline
Sales Assistant I
Anthem
01.2020 - Current
Claims Examiner II
Anthem
10.2017 - Current
Benefit Analyst
Jawood/Genpact-Nasco
08.2013 - 03.2014
Caregiver
Self Employed
01.2012 - 01.2016
Benefit Analyst Consultant/Benefit Analyst
Wellpoint/Anthem - Indianapolis, IN
02.1997 - 05.2012
Some College (No Degree) - Business Administration
Indiana Institute of Technology - Indianapolis, IN, US
High School Diploma - General Studies
George Washington High School - Indianapolis, IN, US
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