Amanda Devoe-Marin Email & Phone Number

Maintain a multimillion-dollar renewal book of business in the Public & Labor sector. Work closely with account executives to provide financial proposal packages and data as needed. Delegate workflow with neighboring underwriters in pharmacy and stop loss for groups with multiple products. • Manage renewal book of business, 18 - 20 groups at a time; fully insured and self-insured. • Subject Matter Expert for two work groups - Critical Coverage Tester and SRM tool • Review large claim reports with impacts on financial data that impact proposal packages. • Assist with coordinating annual account charges and approving chargers for retention and claim wire billing / direct bill. • Maintaining updated understanding of new programs, network discounts, products for pricing and restrictions.• Detail orientated with strong research and communication skills.

United States

Fully insured new business and renewal underwriter for mid to large groups (51-200) for commercial groups. Work with account executives and actuary to produce accurate group rates for optional benefits and other plan addons.• Review experience and manual credibility to evaluate profit margins versus target margins.• Apply and evaluate participation, contribution and medical loads.• Review high-cost claims reports and medical questionnaires to asses appropriate medical loads, this involves high claim knowledge along with an understanding of co-morbidity and mortality.• Create Schedule A Report• Review alternate requests for current groups requiring changes to plans, rates and plan addons

Jacksonville, Florida, United States

Manage grievance cases filed by members for Medicare compliance. • Analyze member complaints and inquiries – spectrum varies between claims, account receivables, fraudulent activity, quality of services, and care from providers.• Work with other departments to bring case into compliance with Medicare - Claims, Appeals, Billing, and Enrollment departments based on need.• Assist management with complex and/or high-value claim cases.• Educate and coach internal departments on the grievance and appeals processes.• Coordinate member care with Case Management. • Process QIO (Quality Improvement Operations) requested for Medicare members per Medicare guidelines when the quality of care was questioned and members felt harmed.

Jacksonville, Florida, United States

Processed claims within Medicare and Aetna guidelines. Including HMO, PPO Local, PPO ESA, and standard plans.• Process claims above production target.• Knowledge of office, hospital, home-health, emergency, urgent care, injections and dialysis claims. • Create overpayment and cost-to-charge (CCR) targets.• Created Excel reports for auto fiscal intermediary (FI) rates for cancer hospitals, leading to faster claims processing turnaround times.• Review disability claims for code morbidity and mortality.

Jacksonville, Florida, United States

Assessed appeals based on clinical guidelines and Medicare guidelines.• Partnered with Nurses to conduct clinical record reviews.• Assessed claims for additional payment, overpayments, and AIG demands. • Restructured office workflow for processing overpayments, reducing departmental cost and increasing production.

Jacksonville, Florida, United States

Rotated between patient care, health unit coordinator and monitor tech / 12 lead EKGs• Cardiac & Pulmonary Monitor Tech & 12 lead EKG technician. Watched 45 beds at central monitor on Heart 3 South – cardiac, pulmonary, blood pressure, MAP’s based on specific parameters per patient. i.e. balloon pump, IV drugs, hypothermia, and ect.) • Assisted in code blues & nurses with patient care including blood draws and prep patients for heart catheter procedures.• Worked with ANM with monthly wound care for unit. • Perform admitting and discharge paperwork per patient and provide referrals, follow up appointments post-surgery and hospital stay for patients, assisted nurses in updating doctors on lab request, test and updates on values per patient condition.

Associate Of Arts(A.A.)

Bachelor Of Science - Bs, Human Services

Case Management, Group, Environmental & Social Dynamics, Mental Health, Public Health Education & Policy and Diagnosing