Michael A. Email & Phone Number

Remote

• Resolve policy discrepancies; prepare and communicate reconciliation reports to employers.• Build and maintain relationships with employers, brokers, vendors, and regional offices, with a focus on employer groups over $250,000.• Perform daily audits on regional (RBAS) and national accounts that focus on voluntary benefits and universal life coverages contributing to the recovery of over $1M in premium annually.• Communicate with regional accounts and Allstate sales support team to get issues resolved for customers.• Provide training, facilitate meetings, and support for team members.• Provide suggestions for innovation and engineer new standard process.• Document and execute complex processes with minimal supervision.• Track and improve progress of discrepancies identified for a minimum of four months, maintaining communication with internal partners external clients throughout that the process.

Jacksonville, Florida, United States

• Collected, analyzed, and managed data to resolve premium payment discrepancies.• Researched and replied to billing questions, process refunds, and reallocate premiums as necessary.• Managed suspense accounts with over 5,000 policyholders using established departmental procedures, process policy transactions for withdrawn or declined policies, cancellations, billing mode changes, refund checks, and policyholder letters.• Maintained monthly reporting for Accounts to identify any trends.

Jacksonville, Florida, United States

• Audited entire claim submission to determine, review, or apply medical necessity, coverage benefits, discrepancies, and cost containment measures to adjudicate claim.• Reviewed basic pended Medicaid and Medicare claims to determine the appropriateness of the claim status.• Consistently maintained productivity of 20 transactions per hour against departmental standard of 14.• Ensured claims were liquidated in a timely manner and at the appropriate level of reimbursement.

Jacksonville, Florida, United States

• Researched and analyzed appeal claims for payment accuracy, maintained accurate documentation of all appeal information.• Worked with external business partners (physicians, hospitals, providers) to obtain pertinent documentation inaccordance with appeals processing needs and HIPAA regulations.• Created a summary for member appeals with all information gathered to determine outcome of appeal.• Negotiated settlement of claims within designated authority.

Jacksonville, Florida, United States

• Provided phone support for internal BCBSF and all BCBSF plan calls.• Investigated, examined, and reprocessed aged/escalated claims and general inquires.• Processed General Inquiries, Held Claims and Adjustments for all lines of business including Blue Options, BlueChoice, Blue Care and Medicare Advantage inventories.• Provided side-by-side training for claim adjustments.• Supported continuous improvement efforts through the early identification, investigation, and resolution of problems and by communicating and coordinating with cross-functional business partners for completion.• Performed accurate research to improve work processing flow.

Jacksonville, Florida Area

• Processed, adjudicated and adjusted blue card host held claims.• Researched, tracked and adjudicated aged/escalated claims.• Performed accurate research to improve work processing flow.• Processed General Inquiries, Held Claims and Adjustments for all lines of business including Blue Options, BlueChoice, Blue Care and Medicare Advantage inventories.

Jacksonville, Florida Area

• Verified enrollment status on the group and member level, updated records, researched and resolved enrollment system rejections.• Responded to incoming calls and initiate outgoing calls, providing customer service to plan members, providers, and employer groups by answering benefit questions, resolving issues and educating callers.• Maintained and reconciled premium bill, self-bill, and individual billed accounts. Notified clients of premium discrepancies through payment adjustment notices and detailed audits.