Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

SUSAN BOULIGA

MOONACHIE,NJ

Summary

Professional with strong background in policy analysis, prepared to drive impactful results through thorough research, analytical skills, and strategic planning. Known for effective team collaboration and adaptability to meet evolving needs while maintaining high standards. Skilled in data interpretation, policy evaluation, and stakeholder communication, ensuring reliable and actionable insights for decision-making.

Overview

20
20
years of professional experience
1
1
Certification

Work History

Medical Policy Analyst

Horizon Blue Cross Blue Shield of New Jersey
09.2011 - 05.2025
  • Knowledge of BlueCard, Claims Policy Guidelines; Coordination of Benefits; Complaints/ Appeals process; Eligibility Determinations; Insurance claims; Medical Director Case Preps; Medical terminology; Membership systems
  • Review of treating provider and member records
  • Responsible for contacting areas of the Company which handled the case to facilitate fact gathering and thorough understanding of the benefit contract.
  • Assisted in the development of new/less experienced staff through mentoring, coaching and assisting them in the proper handling of eligibility and appeal case reviews

Ofice Registered Nurse, Office Manager

Hackensack Allergy & Asthma
10.2005 - 10.2010
  • Managed and motivated employees to be productive and engaged in work.
  • Accomplished multiple tasks within established timeframes.
  • Maintained professional, organized, and safe environment for employees and patrons.
  • Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.

Education

B.S - Nursing

Rutgers University College of Nursing
Newark, NJ
01-1983

No Degree - Nursing

Clara Maass School of Nursing
Belleville, NJ
06-1979

Skills

  • Soft skills:
  • Strong interpersonal/communication skills
  • Relationship building
  • Collaborative partnerships
  • Client-focused care
  • Reliable
  • Hard skills:
  • Microsoft suite
  • Care Radius
  • Encoder Pro
  • Universal Customer Service Workstation

Certification

  • Registered Professional Nurse-Multi State
  • Licensed by New Jersey Board of Nursing

Timeline

Medical Policy Analyst

Horizon Blue Cross Blue Shield of New Jersey
09.2011 - 05.2025

Ofice Registered Nurse, Office Manager

Hackensack Allergy & Asthma
10.2005 - 10.2010

B.S - Nursing

Rutgers University College of Nursing

No Degree - Nursing

Clara Maass School of Nursing

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