Tobie Sparks-Mayfield
Roxboro,NC
Summary
Highly organized and personable Administrator well-versed in day-to-day operations of a company and their duties include data entry, clerical tasks, scheduling, implementing procedures with 5+ years of experience. Offering strong multitasking, problem-solving and communication skills. Able to maintain meticulous client records while adhering to Privacy standards. Trained in multiple areas and flexible with changing business needs.
Overview
5
5
years of professional experience
Work History
Claims Analyst 1
Premera Blue Cross Of Washington
11.2023 - Current
- Reviewed, analyzed, and resolved claims through the utilization of procedures, reference materials and on-line tools for moderately complex claims.
- Translated data into information acceptable to the claims processing system including follow up on pended claims.
- Prepared claims for return to Provider or Subscriber when additional information is needed.
- Consistently met cycle time/productivity goals that are aligned with corporate objectives.
- Maintained confidentiality of all documents/files.
Enrollment Specialist
Premera Blue Cross Of Washington
09.2020 - 11.2023
- Reviewed and processed paper and electronic plan applications, plan changes and other member eligibility or payment related requests and applied specific rules inherent to each enrollment scenario
- Coordinated and managed enrollment and eligibility exception processes to ensure contract guidelines are met
- Prepared written member or group communications utilizing department standards and templates
- Communicated timely and effectively with various internal departments, producers, agents, subscribers or group administrators regarding eligibility, billing, and payment inquiries.
CSR National Accounts
Amazon & Microsoft
02.2020 - 09.2020
- Answered constant flow of customer calls with minimal wait times
- Updated account information to maintain customer records
- Responded to customer requests, offering excellent support and tailored recommendations to address needs
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
CSR Medicare Supplement - Member
12.2019 - 02.2020
- Assured timely verification of insurance benefits
- Verified client information by analyzing existing evidence on file
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Maintained confidentiality of patient finances, records, and health statuses.
Product Configuration - BQT (Project Loan)
11.2019 - 12.2019
- Used best practices in documentation, data quality and data management
- Kept current existing Policies and Procedures
- Maintained thorough and concise documentation for tracking
- Maintained current knowledge of industry standard code sets, government regulations as mandated.
CSR - Individual Member
10.2019 - 11.2019
- Answered inbound phone calls or correspondence regarding benefit, eligibility, member premium billing, assists members with PCP selection, resolved health plan claim inquiries, and assist with Prior Auth Status
- Followed internal processes and procedures to ensure all activities were performed in accordance with departmental and company policies and procedures
- Created accurate and timely member documentation concerning all inquiries taken in accordance to established protocols to ensure resolution is provided and presented in a clear and accurate manner
- Maintained an awareness of Affordable Care Act regulations with regard to enrollment, billing, grace periods, special enrollment periods, and open enrollment.
CSR - Provider Individual, Med Supp, & Employer
06.2019 - 10.2019
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
- Tracked customer service cases and updated service software with customer information
- Updated account information to maintain customer records
- Participated in team meetings and training sessions to stay informed about product updates and changes.
Education
No Degree BUT have completed 93 College Credits - Healthcare Management Technology
Alamance Community College
Graham, NCSkills
- Provider Relations
- Customer Service
- Data Entry Skills
- Enrollment Procedures
- Microsoft Office, Microsoft Word, Excel, and Outlook
- Insurance Eligibility
- Open Enrollment
- Multi-line Phone System
- 51 WPM
- Verbal and written communication
- Problem-solving
- Phone Etiquette
- Organization
- Care Management (Prior Auths)
- Evicore
- AIM
- Claims
- Data Interpretation
Timeline
Claims Analyst 1
Premera Blue Cross Of Washington
11.2023 - Current
Enrollment Specialist
Premera Blue Cross Of Washington
09.2020 - 11.2023
CSR National Accounts
Amazon & Microsoft
02.2020 - 09.2020
CSR Medicare Supplement - Member
12.2019 - 02.2020
Product Configuration - BQT (Project Loan)
11.2019 - 12.2019
CSR - Individual Member
10.2019 - 11.2019
CSR - Provider Individual, Med Supp, & Employer
06.2019 - 10.2019
No Degree BUT have completed 93 College Credits - Healthcare Management Technology
Alamance Community College
Similar Profiles
Sean KuheanaSean Kuheana
Case Manager at Premera Blue Cross Of WashingtonCase Manager at Premera Blue Cross Of Washington
CURTIS THOMAS IIICURTIS THOMAS III
Audit Specialist at Premera Blue Cross Of WashingtonAudit Specialist at Premera Blue Cross Of Washington
Mahendran SubramanianMahendran Subramanian
Site Reliability Engineer at Premera Blue Cross Of WashingtonSite Reliability Engineer at Premera Blue Cross Of Washington
Christopher ArceoChristopher Arceo
Agile Product Owner IV/Agile Product Manager at Premera Blue Cross Of WashingtonAgile Product Owner IV/Agile Product Manager at Premera Blue Cross Of Washington
Shadiamond TurrentineShadiamond Turrentine
Registered Behavior Technician at Highlights HealthcareRegistered Behavior Technician at Highlights Healthcare