Melissa Samek Email & Phone Number

• Highmark: Installation Design Coordinator, MN Client Installation​July 2015 - present
• Prepare, review, and verify client set-up and maintenance functions in multiple systems.
• Assure that all information is accurate and complete so that downstream systems issue accurately and correctly.
• Review and completes coding of all mainline benefit transactions.
• Analyze and communicate benefit design options to sales, operations, and other areas for new clients, benefit changes requests or product interactions. Strong organization skills and attention to detail.

Pittsburgh, Pennsylvania

• Highmark Health Services: Claims Quality Audit Coordinator​Pittsburgh, PA​January 2014 – July 2015
• Accuracy and completeness of service responses to member and provider inquiries.
• Accuracy of enrollment processes and procedures for member applications and group benefit change forms.
• Accuracy of claims adjudication process as stipulated by the group contracts.
• Research, acquire and maintain current and reliable reference documentation required to conduct each audit review in order to support findings and satisfy potential audits by BCBSA, FEP, etc.
• Issuing Blue Star MTM errors throughout the corporation.

Pittsburgh, Pennsylvania

• Highmark Health Services: Senior Customer Service Rep​Pittsburgh, PA​September 2012 – January 2014
• Resolve customer inquiries and issues using verbal and written communication in a timely, accurate, and professional manner.
• Demonstrate an ability to perform in high pressure, fast-paced conditions while prioritizing and multitasking.
• Supervise, educate, and coach new employees in customer service roles.
• Work cross-functionally with senior management by escalating inquiries when appropriate. Clearly document the issue, customer concerns, and background of the inquiry to date.
• Supervisor calls to manage members with concerns regarding unresolved or escalated issues.

Pittsburgh, Pennsylvania

• Highmark Health Services: Senior Markets Member Services​Pittsburgh, PA​April 2011 – August 2012
• Investigate and articulate customer claim and benefit coverage
• Measure personal quality performance and document workflows to improve customer service processes.
• Manage work queues of myself and other.
• Mentor and train new employees.

Education record

Cosmetology, Cosmetology/Cosmetologist, General

General Studies