Bluegrass Community and Technical College

bryan station high school

Insurance/Banking/Customer Service

•	Review the adjudication of claims for accuracy 
•	Identify and report inconsistencies relative to the adjudication of claims for contract compliance and audit/review findings 
•	Analyze errors to determine their root cause and develop solutions to meet business objects in a timely fashion
•	Prepare and communicate issues and resolutions to supervisors and operational units
•	Compile monthly reports to determine where process improvements are needed

Humana

Medical Claims Examiner

•	Manage multiple projects/assignments while working with various departments to obtain data. 
•	Analyze errors to determine origin and communicate outcomes and solutions (written or verbally) to Team Leads or Frontline Leaders
•	Recommend process improvement activities pertaining to system enhancements or procedural changes
•	Attend meetings and speak knowledgeably about needed process updates
•	Research Termed in Error accounts to limit CTM complaints to Medicare
•	Assisted with remote team relocation to Tampa from Corporate office
•	Utilized PBS to research members premium billing history
•	Reconciled accounts to ensure members billing was accurate
•	Process payments, refunds for members
•	Allocated misapplied payment to ensure perfect Service
•	Resolved billings issues by making outbound calls to members
•	Demonstrate emotional intelligence when dealing with internal as well as external customers
•	Maintained production and quality standards set in place for the billing team

Billing Specialist

•	Meet and maintain production goals while maintaining quality metrics.
•	Utilize research, problem solving, and analytical thinking skills to resolve and determine corrective actions for member enrollment transactions utilizing Humana system programs such as; Hod Mod4 (CI/AE), Customer Care Portal (CCP2), GCP,EXP Macess Service Module, IPNS and Medicare Advantage Drug (MARx) database.
•	Learning and adapting to processes and procedures that change daily while keeping up productive standard
•	Handles personal health information with the utmost security possible and keeping information updated daily with the use of company programs
•	Provide ongoing feedback to enhance associate contribution, competencies, and performance (Team SME)
•	Make and receive member calls regarding their enrollment.
•	Helping to develop processes and provide the tools that are needed to successfully deliver Perfect Service to all customers. (Streamlining LI NET Process Team)
•	Troubleshoot Pharmacy Claims for Low Income Subsidy Members, using the Argus application
•	Research replies to update members enrollment from replies from CMS
•	Assisted Point of Sale claims to assist member in getting prescriptions

Enrollment Specialist

•	Post payments, sales proceeds, payment reversals and adjustments

•	Research monetary items on charged off accounts
•	Provide assistance in monthly loan audit process
•	Distribute loans and loan payments documentation
•	Process check payments for various commercial industries
•	Reviewed customer information ensuring its accuracy
•	Maintained a high level of accuracy while typing 60 wpm
•	Managed statistical analysis for performance management
•	Released collateral on paid out loans
•	Executed closing paid accounts
•	Notarized all mortgage loans

Antonio Travis