Jay Brown, Mba, Clss Gb Email & Phone Number

Carmel, In, Us

Indianapolis, Indiana, United States

United States

• Audited all travel medical and United States Department of State claims daily, maintaining service level agreements by completing audits within 48 hours. • Researched and resolved all travel medical appeals, consumer complaints, Department of Insurance complaints, and Better Business Bureau complaints daily maintaining service level agreements by handling all appeals within 30 days of receipt, and all complaints within 2 weeks of receipt.• Reviewed high dollar guarantee of payments and tiered authorizations for high dollar payments and denials.• Assisted the travel medical claims adjusters each week in both official Quality Assurance help sessions, and on an individual basis to provide support on complex files. • Acted as subject matter expert on multiple lines of business.• Extensively trained and mentored new and seasoned claims adjusters.• Created and maintained process, training, and standard operating procedure documentation.• Monitored and documented audit trends to identify additional training opportunities and provide insights to management.• Interpreted both foreign and domestic medical records, CPT Codes, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records and compared with submitted claims and reconciled against policy wording to ensure proper claim adjudication.

United States

Same responsibilities as Claims Advisor II with the following additional responsibilities:• Trained new advisors and cross trained existing advisors.• Participated in interviews for potential new advisors.• Assisted with workflows in individual working groups to ensure service level agreements were met.• Approved guarantee of payments for emergency situations to foreign providers.• Peer reviewed and quality checked trainees’ work for accuracy and compliance.

Carmel, Indiana

• Processed timely and accurately a high volume of claims across multiple lines of business, averaging 80 claims per day.• Consistently earned a quality score of 99.5% or higher.• Reviewed and adjusted specialized trip insurance claims involving baggage damage, delay, and loss.• Investigated and settled travel related personal property claims resulting from losses such as theft, violence, natural disasters and common carrier negligence. • Regularly read and reviewed medical records involving complex medical claims. • Investigated suspicious and potentially fraudulent claims. • Provided support to the international assistance coordinators by verifying benefits and eligibility for emergency evacuations and repatriations.• Served as subject matter expert representing the claims department in working groups for new product rollouts and designs. • Responded to all customer calls and contacts within 24 hours.

Carmel, Indiana

•Managed the undeliverable check process from beginning to end for the entire company.•Implemented process improvement project to convert manual processes to automated processes.•Eliminated labor required to process undeliverables by approximately 20 hours per week freeing more time for other duties.•Reduced paper consumption by 6000 sheets per month.•Supported Special Investigations, Fraud and Legal units.•Answered inquiries and conducted research on accounting related issues for Insurance Operations and Customer Service.

Carmel, In

•Processed all stop pay and void transactions for the entire company within 24 hours.•Decided final disposition on all suspicious check items presented on the daily positive pay report.•Instigated special financial systems projects to fix broken admin systems from previous acquisitions. •These projects cut processing time of previously manual processes by 50%.•Researched and reconciled bank and general suspense accounts.•Answered all check status inquiry requests within 24 hours.

Carmel, In

•Matched checks with approvals and correspondence and mailed them directly to policy holders and independent marketing organizations.•Issued all manual checks and verified proper approval.•Instituted process improvements to the manual check mailing process reducing turn around time by 3 hours each day.

Indianapolis, In

•Recovered .10% of all estimated lost revenue on oversize and overweight packages.•Trained all new revenue recovery auditors in the primary unload.•Supervised 15-20 auditors across 54 unload docks.•Monitored incoming loads and assigned auditors based on ability and skill set.•Assisted with auditing packages as needed.

Indianapolis, Indiana Area

•Executed special events, contests, and other promotions.•Designed press releases and brochures.•Created promotional advertisements and liners.•Brainstormed ideas for new promotions.

Indianapolis, Indiana Area

•Directed the daily operations of the service department.•Supervised 5 employees.•Tracked and monitored incoming and completed customer repair units.•Assisted customers in person and via phone with such issues as missed deliveries and installations, repair problems, and new product failures.

Indianapolis, In

•Hired and trained employees.•Balanced and audited daily cash flow.•Received and merchandised weekly inventory.•Balanced and reconciled inventory on a monthly basis.•Calculated and entered weekly payroll.•Instigated new procedures which provided better customer service and reduced shrink.

Master Of Business Administration (M.B.A.), Applied Management, 3.9

Bachelor Of Science (B.S.), Telecommunications Corporate And Institutional Media, 3.0

Activities and Societies: WCRD F.M. International Television Association