• Worked with the Office of Personnel Management (OPM) in Washington DC for the Federal Government Employees• Developed a process to resolve 5 years of outstanding claims adjudication for OPM; documented the process; trained other associates and eliminated the backlog• Retrieved funding from claims that was not processed correctly, paid to incorrect payee, overpaid by processing or duplicated or erroneously billed• Processed claims for payment based on code guidelines, CPT and ICD-9/ICD-10 information submitted • Initiated refunds to providers and subscribers• Flagged providers that continued to bill for services not rendered• Audited random claims for accuracy, validity and compliance through OPM audit system

• 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.• Reprocessed claims that were incorrectly processed for additional payments or overpayment

• 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

• Processed claims for payment based on code guidelines, CPT and ICD-9 information submitted• Quality assurance – reviewed claims for accuracy