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.

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accounts with over 5,000 policyholders using established departmental procedures, process policy transactions for withdrawn or declined policies, cancellations, billing mode changes, refund checks, and.
• 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.