babybiv
New
Hi,
I am looking for a position that would allow me to use my insurance experience and
my coding certification. I have an extensive background in auditing and problem solving issues.
Lynn A. Brockman
223 Valley Street
McDonald, PA 15057
H -724-926-3869
C - 412-720-2821
babybiv@verizon.net
Employment
MCOA GROUP INC. Pittsburgh, PA
MCA Administrators, Inc. 2010-Present
Technical Assistant
Handle various projects as needed for the Director of Claims – these include refunds (sending letters to providers and tracking receipt of monies), Medicare Secondary Payer Recovery situations, eligibility projects, subrogation cases, audits, preparing plan documents and amendments
Enterprise Underwriting Services, Inc.
Stop Loss Claims Manager 2006-Present
Work with the underwriters, TPA's and reinsurance carriers for EUS
Work with the cost containment departments of the TPA's in handling transplant contracts
Process and authorize reimbursements for stop loss claim submissions
Submit monthly reports to management and carriers
Review and approve Plan documents and amendments
Maintain the Claims Module of the Office Manage software program
Stop Loss Claims Auditor 2001-2005
Reviewed, evaluated and processed TPA Reinsurance claims for reimbursement
Reviewed and approved Plan documents and amendments
Maintained the Claims Module of the Office Manager software
Managed Care of America
Claims Auditor 2001
Audited claims processed by TPA claims processors
Maintained accuracy reports
HIGHMARK LIFE AND CASUALTY Pittsburgh, PA 1996-2001
Stop Loss Claims Examiner/Senior Stop Loss Claims Examiner
Reviewed, evaluated and processed Reinsurance Stop Loss Claims
Worked with both specific and aggregate claims for TPA's nationwide
Interpreted Plan Documents and Stop Loss Policies
Responsible for positive relationships between TPA's and claims office
Worked with sales office, brokers and underwriters, cost containment unit
and outside vendors
Analyzed monthly aggregate reports and prepared monthly summaries for senior management
Assisted Claims Intake Unit and Systems Department with computer problems
Performed on site TPA approvals for Preferred TPA program
DIVERSIFIED GROUP ADMINISTRATORS/NOBEL GROUP BENEFITS
Canonsburg, PA 1985-1996
Technical Support Supervisor
Responsible for training of new employees and retraining of current staff
Managed work flow, audits and referrals
Developed claims training manual
Handled reinsurance situations-reports and filing of specific claims
Handled referrals between supervisors and reinsurance carriers
Unit Supervisor
Supervisor of three claims examiners
Managed workflow, dealt with problems between plan members and providers
and plan members' interpretation of plan
Coordinated the prescription program
Formed the UMWA claims unit
Represented DGA at Health Care Exchange Group Meetings
BABB, INC. (Higham-Whitridge, Inc.) Pittsburgh, PA 1980-1985
Claims Examiner
Evaluated claims for payment or denial
Corresponded with insured, schools, providers of service and underwriters
Account Representative
Responsible for preparation and distribution of policies, brochures and applications
Received records and balanced premiums and applications
Prepared monthly reports for underwriters
CARNEGIE-MELLON UNIVERSITY Pittsburgh, PA 1979-1980
Secretary Electrical Engineering Department
Typed technical papers and grant proposals
Greeted visitors and assisted staff with department functions
BABB, INC. (Higham-Whitridge, Inc.) Wayne, PA 1979
Claims Examiner
Interpreted medical plans
Evaluated claims for payment or denial
Corresponded with insured, schools, providers of service and underwriters
Formal Education
Bachelor of Science Biology La Roche College Pittsburgh, PA 1979
Professional Education
Medical Coding – Allied Business Schools, Inc. 2011
Certificate of Completion
Advanced Medical Terminology – Allied Business Schools, 2010
Certificate of Completion
Various web seminars and medical teleconferences offered by
URN/OptumHealth, INGRe and Interlink 2005-2010 Business as Unusual for Individual Contributors 1999
Business as Unusual for Individual Contributors 1999
Lotus Notes 4.5 1998
Windows NT 4.0 1998
Excel for Windows Level 1 1997
Word for Windows Level 1 1997
cc:Mail 1997
RIMS 1996
WordPerfect for Windows Level 1 1996
Quattro Pro 6.0 1996
Access Level 1 1996
HIAA Group Life/Health Part A, B, C Certificate 1987
Health Basic Fast- Track “Legal Concepts and Doctrines” 1987
Certification
American Association of Professional Coders – AAPC
Certified Professional Coder March 2011
Membership
AAPC – Greater Pittsburgh Chapter November 2010
I am looking for a position that would allow me to use my insurance experience and
my coding certification. I have an extensive background in auditing and problem solving issues.
Lynn A. Brockman
223 Valley Street
McDonald, PA 15057
H -724-926-3869
C - 412-720-2821
babybiv@verizon.net
Employment
MCOA GROUP INC. Pittsburgh, PA
MCA Administrators, Inc. 2010-Present
Technical Assistant
Handle various projects as needed for the Director of Claims – these include refunds (sending letters to providers and tracking receipt of monies), Medicare Secondary Payer Recovery situations, eligibility projects, subrogation cases, audits, preparing plan documents and amendments
Enterprise Underwriting Services, Inc.
Stop Loss Claims Manager 2006-Present
Work with the underwriters, TPA's and reinsurance carriers for EUS
Work with the cost containment departments of the TPA's in handling transplant contracts
Process and authorize reimbursements for stop loss claim submissions
Submit monthly reports to management and carriers
Review and approve Plan documents and amendments
Maintain the Claims Module of the Office Manage software program
Stop Loss Claims Auditor 2001-2005
Reviewed, evaluated and processed TPA Reinsurance claims for reimbursement
Reviewed and approved Plan documents and amendments
Maintained the Claims Module of the Office Manager software
Managed Care of America
Claims Auditor 2001
Audited claims processed by TPA claims processors
Maintained accuracy reports
HIGHMARK LIFE AND CASUALTY Pittsburgh, PA 1996-2001
Stop Loss Claims Examiner/Senior Stop Loss Claims Examiner
Reviewed, evaluated and processed Reinsurance Stop Loss Claims
Worked with both specific and aggregate claims for TPA's nationwide
Interpreted Plan Documents and Stop Loss Policies
Responsible for positive relationships between TPA's and claims office
Worked with sales office, brokers and underwriters, cost containment unit
and outside vendors
Analyzed monthly aggregate reports and prepared monthly summaries for senior management
Assisted Claims Intake Unit and Systems Department with computer problems
Performed on site TPA approvals for Preferred TPA program
DIVERSIFIED GROUP ADMINISTRATORS/NOBEL GROUP BENEFITS
Canonsburg, PA 1985-1996
Technical Support Supervisor
Responsible for training of new employees and retraining of current staff
Managed work flow, audits and referrals
Developed claims training manual
Handled reinsurance situations-reports and filing of specific claims
Handled referrals between supervisors and reinsurance carriers
Unit Supervisor
Supervisor of three claims examiners
Managed workflow, dealt with problems between plan members and providers
and plan members' interpretation of plan
Coordinated the prescription program
Formed the UMWA claims unit
Represented DGA at Health Care Exchange Group Meetings
BABB, INC. (Higham-Whitridge, Inc.) Pittsburgh, PA 1980-1985
Claims Examiner
Evaluated claims for payment or denial
Corresponded with insured, schools, providers of service and underwriters
Account Representative
Responsible for preparation and distribution of policies, brochures and applications
Received records and balanced premiums and applications
Prepared monthly reports for underwriters
CARNEGIE-MELLON UNIVERSITY Pittsburgh, PA 1979-1980
Secretary Electrical Engineering Department
Typed technical papers and grant proposals
Greeted visitors and assisted staff with department functions
BABB, INC. (Higham-Whitridge, Inc.) Wayne, PA 1979
Claims Examiner
Interpreted medical plans
Evaluated claims for payment or denial
Corresponded with insured, schools, providers of service and underwriters
Formal Education
Bachelor of Science Biology La Roche College Pittsburgh, PA 1979
Professional Education
Medical Coding – Allied Business Schools, Inc. 2011
Certificate of Completion
Advanced Medical Terminology – Allied Business Schools, 2010
Certificate of Completion
Various web seminars and medical teleconferences offered by
URN/OptumHealth, INGRe and Interlink 2005-2010 Business as Unusual for Individual Contributors 1999
Business as Unusual for Individual Contributors 1999
Lotus Notes 4.5 1998
Windows NT 4.0 1998
Excel for Windows Level 1 1997
Word for Windows Level 1 1997
cc:Mail 1997
RIMS 1996
WordPerfect for Windows Level 1 1996
Quattro Pro 6.0 1996
Access Level 1 1996
HIAA Group Life/Health Part A, B, C Certificate 1987
Health Basic Fast- Track “Legal Concepts and Doctrines” 1987
Certification
American Association of Professional Coders – AAPC
Certified Professional Coder March 2011
Membership
AAPC – Greater Pittsburgh Chapter November 2010