Licensed child care provider - in home care

• Work with the Office of Personnel Management (OPM) in Washington DC for the Federal Government Employees• Retrieve funding from claims that was not processed correctly, paid to incorrect payee, overpaid by processing or duplicated.

• Updated records related to reconsideration requests and appeals of medical review, claims review, billing and other complaints by FEP members or providers.• Provided correspondence and/or responses to overturn records or any record of action taken by the Office of Personnel Management (OPM)• Processed oral and written correspondence to determine accuracy of claim payments• Other duties included but were not limited to: Updating Appeal Overturn Records, BCBSFL Responses, Medical Review Records, OPM Correspondence and Reconsideration Requests.

• Replied to written correspondence from doctors and patients concerning unpaid medical claims.• Other duties included but were not limited to: Administration of Check copies, clams, adjudication, adjustments, notes processing, explanation of benefits, provider statements and supporting documentation

• Processes paid claims• Design and write technical specifications based on requirements.