Florida Blue

• Handle relations between the Providers, customers, and processing team by anticipating needs, problem resolution, and improved communication
• Liaison between Providers and Members for claims processing of multiple inventories
• Conduct meetings with third party Providers to resolve high priority claims

Provider Service Advocate IV

Firstsource

•Research adjustments and re-submissions across multiple states.
•Assists with defect reduction by identifying and communicating error issues and potential solutions to management.
•Helps to improve overall performance accountability (attendance, communication, flexibility, adaptability, interpersonal skills, teamwork and cooperation). 
•Adjudicates or re-adjudicates claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.

Claims Adjuster

•	Developed goals, designed policies, and implemented procedures to reduce claims processing errors and inventory backlog
•	Handled relations between the Providers, customers, and processing team by anticipating needs, problem resolution, and improved communication
•	Assisted with staffing activities including interviewing, orienting, training, scheduling, developing, auditing, and continuing education
•	Performed tactical planning to ensure quality standards with the audit team are met through written inquiries

Senior Advisor

•	Liaison between Providers and Members for claims processing of multiple inventories
•	Created and implemented the First Contact Resolution procedure to optimize the caller experience and reduce claims processing errors
•	Served on the Process Improvement Committee that improved workflows and turnaround time 
•	Conducted meetings with third party Providers to resolve high priority claims

Claims Examiner

First Coast Service Options

•	Served as the Subject Matter Expert in soft skills for resolving call escalations
•	Provided training, coaching, feedback, and continuing education to new employees
•	Strategic planning for customer satisfaction and inventory reduction

Customer Service Representative

Rita's Italian Ice

•	All day-to-day managerial duties including quality customer service, employee supervision, training, inventory, accounts receivable, and bank deposits.

Day Time Manager

I am a Provider Service Advocate in Florida Blue, where I apply my 15+ years of experience in health insurance claims processing to research, adjudicate, and resolve complex claims and re-submissions. I have a strong analytical and communication skill set that enables me to identify and communicate error issues and potential solutions to management, as well as to handle relations between the providers, customers, and processing team.

I am passionate about enhancing claims management using a qualitative and value-based approach, and I have developed and implemented policies and procedures to achieve this goal. I have also participated in the L.E.A.D Graduate program and obtained several certifications to expand my skills and knowledge in leadership, technical support, and effective communication. I am a highly disciplined and results-driven team motivator who strives to make a positive impact on the organization and the community.

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