Vanessa Jackson Email & Phone Number

Houston, Texas

Houston, Texas

Answered phones, triaging calls to appropriate staff member.Accepted letters and packages delivered to the front desk and distributed them to appropriate staff.Provided general office support with a variety of clerical activities and related tasks, including scanning and downloading documents for entry into the Kinnser Home Health Care system, faxing and.

Houston, Texas Area

• Client: Arthur J. Gallagher & Co.Clarified benefit plan offerings to employees, addressing specific questions.
• Assisted employees with finding in-network providers for health plans.
• Processed enrollment forms through carrier or client eligibility maintenance system (e.g. BenefitSolver).
• Confirmed eligibility for members through carrier or client eligibility maintenance system.
• Acted as employees’ advocate during conference calls with employee and benefits provider (medical provider, carrier, etc.).

Greater Seattle Area

Client: USI Insurance ServicesMember of Clean-up Project Team which assisted the client’s Employee Benefits Accounts Managers in their personalized BenefitPoint web source for benchmarking. Data used to provide status updates to local Operational resources.

Houston, TX; Cleveland, OH

• Clients: Kaiser Permanente of Colorado, HealthSpan OhioAdjudicated claims for Group, Medicare and Exchange products administered by the clients, as well as ad-hoc projects as determined by client.
• Advised client of deficiencies in Desk Level Procedures document regarding processing steps for a specific type of claims hold issue which was subsequently updated based upon that advisement.
• Selected to train a class in processing an individual claims hold issue on online platform.
• Achieved 100% for Financial, Procedural and Clerical Quality in several quarters.

Shelton, CT; Bourbonnais, IL; Woodland Hills, CA; Denver, CO; Winston-Salem, NC

• Clients: HealthNet, CIGNA, Anthem, Inc. Researched claims issues and responded in accordance to plan policies and procedures with adjustments or advisements of the research results. Assisted members in network provider.
• Mentored new hires on handling customer service calls.
• Discovered system problem which erroneously denied services billed with the correct POS code.

Oklahoma City, Oklahoma Area; Birmingham, AL; Syracuse, NY

Clients: National Government Services, Cahaba GBA, Electronic Data Systems.Adjusted claims as per order of benefit determination. Investigated evidence of other coverage and referred information to appropriate department for update of beneficiary files.Answered inquiries of participating Medicare Part B providers, including but not limited to eligibility.

Houston, Texas Area

Located households and conducted interviews with respondents, explaining the purpose of the Census. Recorded responses and turned in completed forms.

Denver, CO

Client: Anthem, Inc.Reviewed and processed claims suspended from network re-pricing due to various edits. Verified provider data. Re-routed misdirected claims back to source system.

Houston, TX

Clients: Community HealthChoice, Heritage Health SystemsAdministered benefits for Medicare Advantage and Commercial products, and the Medicaid and Children’s Health Insurance Program for the State of Texas.

Houston, TX

Adjudicated claims for the Medicare Advantage products offered by the carrier. Answered telephone inquiries regarding the introduction of its Fee-for-Service product, including eligibility, multiple plan options and premium questions.

The Woodlands, TX

Client: Hewitt AssociatesResearched payroll and benefits information as needed by the Human Resources Outsourcing Group. Performed checks ensuring data processing jobs ran properly and files were sent to and received from Clients and Third Parties (e.g. COBRA information, Qualified Status Change, Enrollment elections). Completed projects as assigned by the.

Houston, Texas

• Analyzed and reviewed claims appeals submitted by providers. Submitted requests for claims adjustments and/or recoupments to the contracted Third Party Administrator. Recorded appeals and reviewed results into monthly.
• Created standard letter templates for acknowledgment and resolution of appeals.
• Created spreadsheet which tracked entry, results, completion and average turnaround time of appeals.
• Proofread outgoing appeals resolution letters and spreadsheets created by other analysts.
• Revised network provider fee schedule under direct supervision of Medical Director.
• Handled high-priority and escalated claims issues referred by the Medical Director.

Houston, TX

Clients: Houston Independent School District, Aldine Independent School DistrictTrained Houston Independent School District Benefits Ambassadors and Coordinators to assist employees during benefits enrollment period and provide information and benefit responses on an ongoing basis. Tested new Benefits Outlook system for processing errors prior to Houston.

Houston, TX

• Client: MercerAssumed the duties of the BenefitPoint platform project which included screening documents for plan information, member eligibility, employee contribution and plan rates for entry into the website. Peer.
• Trained new team members on BenefitPoint.
• Assisted both sales leads and service leads in client renewals and proposals for client prospects.
• Created master client data spreadsheet combining carrier contacts

Sugar Land, TX

• Adjudicated and adjusted group medical claims for multiple products. Processed executive-level members’ claims.
• Created and maintained claim file notes for tracking managed care claims, eliminating turnaround time. Initiated use of claim file notes, which were adopted by other team members.
• Mentored customer service professionals and service consultants in telephone inquiries regarding claims adjudication and plan contracts.
• Handled high-priority claims issues referred by supervisors and customer service professionals.
• Created macros for repetitive tasks, which increased productivity by 30%.
• Selected by supervisor to act as sole processor of oral surgery claims for claims office.

Houston, Texas

• Administered benefits according to policyholders’ specifications. Facilitated management’s customer inquiries. Investigated and reviewed claims for fraudulence and billing inaccuracy. Interpreted policy provisions.
• Discovered system problem, which inaccurately accumulated maximum benefits for plan
• Processed executive, Flexible Spending Account and Short-Term Disability claims.
• Assisted on difficult customer service calls.
• Trained new hires on handling customer service calls.