Tamara George
Middletown ,NY
Summary
Dedicated and results-driven professional with over 20 years of experience in medical insurance. Proven expertise in building and maintaining strong provider relationships, resolving escalated issues, and ensuring compliance with Medicare coordination of benefits. Adept at delivering exceptional customer service and streamlining processes to improve provider satisfaction. Known for excellent communication, problem-solving skills, and deep knowledge of health insurance policies and regulations.
Overview
21
21
years of professional experience
Work History
Provider Relations Specialist
Anthem Blue Cross Blue Shield
Middletown, NY
03.2019 - Current
- Serve as the primary liaison between BCBS and healthcare providers, ensuring smooth communication and resolution of escalated provider issues.
- Monitor provider satisfaction, and implement strategies to improve engagement and retention.
- Conduct provider orientations and educate practices on policies, portal usage, and claims procedures.
- Work closely with internal departments, including credentialing, claims, and IT, to streamline provider support.
- Generate reports summarizing findings from investigations into potential violations of contractual obligations or regulatory requirements by network providers.
- Participate in negotiations with external vendors concerning the terms of service agreements.
Coordination of Benefit Specialist
Anthem Blue Cross Blue Shield
Middletown, NY
04.2015 - 03.2019
- Investigated and processed Medicare coordination of benefits (COB) to ensure proper payment sequencing, and reduce overpayments.
- Collaborated with CMS, members, and providers to gather accurate insurance information and verify Medicare primary/secondary status.
- Updated systems with correct Medicare effective and termination dates using the CMS portal.
- Audited and corrected claims to comply with federal COB regulations to prevent duplicate payments.
- Provided detailed explanations to members and providers regarding COB procedures and Medicare guidelines.
Customer Service Representative
Anthem Blue Cross Blue Shield
Middletown, NY
12.2004 - 04.2015
- Delivered high-quality service to members by addressing inquiries related to benefits, eligibility, claims, and authorizations via telephone, chat, and emails.
- Resolved customer concerns efficiently and empathetically, maintaining a consistent satisfaction rating.
- Supported open enrollment and plan changes, educating members on plan options and network coverages.
- Trained new hires on call handling, system navigation, and policy interpretation.
Education
Associate of Arts - Marketing
Katherine Gibbs
New York, NY06-1998
Skills
- Provider network relations
- Medicare coordination of benefits (COB)
- Claims resolution and investigation (eg, NASCO, WGS, CS90)
- Provider onboarding and education
- Regulatory compliance (CMS, HIPAA)
- Problem solving and conflict resolution
- Data analysis
- Process improvement
Timeline
Provider Relations Specialist
Anthem Blue Cross Blue Shield
03.2019 - Current
Coordination of Benefit Specialist
Anthem Blue Cross Blue Shield
04.2015 - 03.2019
Customer Service Representative
Anthem Blue Cross Blue Shield
12.2004 - 04.2015
Associate of Arts - Marketing
Katherine Gibbs
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