Summary
Overview
Work History
Education
Skills
Affiliations
Certification
References
Timeline
Generic

Tamela Laney

Baltimore,MD

Summary

Versatile Analyst specializing in functions within healthcare. Intelligent, insightful and pragmatic with resourceful and detail-oriented approach. Versed in Microsoft applications and familiar with all facets of operations. Knowledgeable and dedicated professional with extensive experience in the medical and dental insurance industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.

Overview

25
25
years of professional experience
1
1
Certification

Work History

Functional Analyst

CareFirst BCBS
Canton, MD
03.2022 - Current
  • Provides Operations Support by obtaining facts; analyzing problems; designing solutions; developing testing methods; conducting and documenting tests; providing operating information to customers.
  • Responsible for loading and maintaining Delegated practitioners in Provider Systems and ensuring all provider data is accurate and complete to supply the organization with provider data and support directories, while ensuring compliance with regulatory, accreditation, legal and company requirements and standards.
  • Supports operations systems by providing operating information to customers; answering questions;providing training.
  • Lead Delegated calls to communicate statuses and discuss issues and priority work.
  • Contributes to operations analysis and organization success by welcoming related, different, and new requests; helping others accomplish job results, development of Standard Operating Procedures (SOP) and other essential documentation, work with Enterprise Managers and other applicable areas for
    resolutions, provider file reconciliations, audits, and project related work for Delegated providers.
  • Keeps Manager abreast of concerns or problems with delegated processes.
  • Consulted with management to reach agreement on system principles.
  • Presented findings from data analysis in a clear and concise manner.

Customer Service Advocate 2

CareFirst Blue Cross Blue Shield Inc.
Owings Mills, MD
11.2007 - 03.2022
  • Uses knowledge of products and contract provisions to provide customer service and education, to interpret contractual language to customers and healthcare providers through telephonic inquiries, written and/or electronic inquiries
  • Calculates and verifies deductibles, maximums, co-payments, and coinsurance for resolving inquiries, facilitating adjustments, initiating extra contractual and reporting of any systems processing errors, overpayments, and underpayments
  • Also updates and advise information regarding coordination of benefits with other insurance companies
  • Examines adjudicated claims to identify key elements and processing requirements based on diagnosis, procedure, provider, medical policy, contracts, and policy procedures
  • Researches, investigates, and initiates resolution of pends by the processing system
  • Recognized with the SQM high achievement award for exceeding the SQM requirements within the Federal Employment Program unit with excellent customer service.

Account Service Representative 2

Amerix Corporation
Columbia, MD
10.2002 - 07.2005
  • Maintained accounts of customer debts by paying each provider monthly and managed payments allocated to each provider to ensure timely monthly payments
  • Helped members consolidate all creditors/debtors into 1 monthly payment resulting in debt relief in 2-5 years, buy negotiation of interest rates and fee waivers with creditors/debtors.

Customer Service Representative

MCI Communications
Hunt Valley, MD
01.2000 - 08.2002
  • Assisted customers with MCI products and services to include local and/or long-distance telephone services as well as landline services
  • Maintained customer accounts for telephone services with focus on addressing customer needs by managing their billing statements, by updating needed telephone services and telephone features with consistent excellent customer service via telephone support
  • Sent trouble tickets to the technical support if there was a problem with local telephone service.

Assistant Manager

New York and Company
Annapolis, MD
05.1999 - 12.1999
  • Recruited and retained top talent employees, with focus on completing timely performance evaluations, providing positive feedback and rewarding superior performance
  • Exceeded sales goals and accomplished business objectives by inspiring staff and promoting target products
  • Trained team members in successful strategies to meet operational and sales targets as well as handling of cash
  • Completed 3 inventory counts to verify stock levels, address discrepancies and forecast future needs.

Education

Psychology -

South University Online
01.2024

Business Administration -

Argosy University Online
01.2018

High School Diploma -

Mergenthaler Vocation- Technical High School

Skills

  • Training development aptitude
  • MS Office proficiency
  • Medical terminology knowledge
  • Staff education and coaching
  • Professional telephone demeanor
  • Key holder experience
  • Customer Service
  • Microsoft Word
  • Workflow Improvement
  • Windows 95/98/2000/XP/XP Pro/NT

Affiliations

  • Member, Empowerment Temple Church, 2013 to Current
  • Finance, Alumni Committee Mergenthaler Vo-Tech High School Class of 1993, 2019 to Current

Certification

Certified Foster Care Parent in Maryland since 2017

References

Reference available upon request

Timeline

Functional Analyst

CareFirst BCBS
03.2022 - Current

Customer Service Advocate 2

CareFirst Blue Cross Blue Shield Inc.
11.2007 - 03.2022

Account Service Representative 2

Amerix Corporation
10.2002 - 07.2005

Customer Service Representative

MCI Communications
01.2000 - 08.2002

Assistant Manager

New York and Company
05.1999 - 12.1999

Psychology -

South University Online

Business Administration -

Argosy University Online

High School Diploma -

Mergenthaler Vocation- Technical High School

Similar Profiles

CREATE PROFILE
Tamela Laney