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Lauren Bennetts, BSA, GLHIA

Medicare/Medicaid Claims Insurance professional

Greenfield, WI

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Summary:  
 
Bachelor's degree in Accounting and Insurance professional with extensive experience in Medical claims processing with specialization in Medicare/Medicaid claims, COB and Reconsideration. Background also includes agent licensing terminations. 99 - 100% accuracy.  
Follows through on commitments while  
representing data and information correctly. Proficient in 
a variety of Insurance processing systems.  
 
Successfully completed Bachelors of Science in Business in Accounting

Work Experience

Grievance and Appeals Rep

Accounting Principals (formerly Ajilon Finance)
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August 2010 to August 2011

Duties: Case set up of appeal requests from providers and beneficiaries, ordering medical records for the beneficiary appeals requests. Forward cases to Med. Review nurses after set-up completion. Working special projects including records importation for special cases involving appeal requests of overpayment determinations for review by the medical review nurses asigned to those specific types of cases.  
Case set up accuracy is 100%. 
Systems used: Maars, FISS, and Case 360

Benefits Specialist

Insurance Overload Staffing
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November 2009 to February 2010

Assigned to United Health Group  
Reimbursements Department 
 
* Processing Flex Spending Account  
* Systems used Citrix, ClaimsPro, Metavante 
* Proven dependibility 
* Demonstrated fast learner of new processes

LICENSING SPECIALIST

American General Life Companies
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January 2009 to June 2009

* Responsible for handling Agent license and appointment terminations per requests received from agents in the agent's hierarchy or from one of the State Insurance Depts due to reasons such as license expired or Contuining Education requirements (Compliance) not met. 
 
* Successfully completed training on 6 separate systems used in the process of agent terminations within 3 months of being in position, exceeding expectations 
 
* Continued handling and completing processing commissions reports for agents' of client serviced from prior position while training for this position

LIASION I - INSUREDESK 2008

AMERICAN GENERAL LIFE BROKERAGE
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August 2006 to December 2008

• Gained knowledge in policy assembly improving efficiency and policy delivery  
• Successfully completed training on quote processing to assist sales agents based on term, face amount, premium frequency 
• Successfully completed 2 lengthy agent licensing reports for client to confirm status of appointments requested, resubmitted requests to American General’s licensing department as needed, emailed completed reports back to client noting dates appointments completed or resubmitted.

LIASION

INSURANCE OVERLOAD STAFFING
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August 2006 to July 2008

Assigned to American General 
 
2007-2008 
(3 Mth break) 
2006-2007 
 
* Quality checked policies prior to printing, assembling 
and mailing via American General’s Cyberlife and AWD 
systems 
 
* Used MS Excel to create commission reports for data entry 
of commission payment in our client’s system and to 
complete agent licensing appointment requests by creating 
spreadsheets using appointment data provided by client 
 
* Mailed rush policies for other department staff, 
demonstrating flexibility

CALL CENTER CUSTOMER SERVICE REP - BOOK PROGRAM

Reiman Publications
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February 2003 to August 2006

* Successfully cross-trained in all three call center departments 
* Customer serviced in-bound order calls in a call center environment 
* Data entered orders while talking to customer during call 
* Successfully handled order processing for magazine subscriptions, cookbook orders, catalog orders, and gift orders

CALL CENTER CUSTOMER SERVICE REP - SUBSCRIPTION SERVICES

TRC STAFFING AT REIMAN MEDIA GROUP
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August 2002 to February 2003

* Successfully cross-trained in all three call center departments 
 
* Successfully serviced calls for orders of cookbooks, and 
catalog merchandise, subscription orders and renewals; 
gift orders

CLAIMS SERVICE REPRESENTATIVE

Claims Services Resource Group (CSRG)
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April 1998 to December 2000

* Exceeded accuracy expectations consistently on all assignments 
* Successfully trained on several industry based and home grown systems including Humana's Badger and Macess 
* Successfully reviewed, reprocessed or denied claims overpaid or under paid 
* Successfully handled refund requests on overpayments 
* Worked up from contingency staff to service center staff, 
including working for clients such as: Humana, Great West 
Life, and Aetna.

CLAIMS EXAMINER

CSRG - CONTINGENCY STAFFING
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April 1997 to April 1998

* Successfully handled and assisted TPA client at their 
location with re-pricing of claims prior to submission to 
insurance carriers for adjudication 
 
* Assisted with sorting and matching of repricing reports with original claim paperwork 
 
*Succeeded expectations using client's Amysis system

SENIOR SERVICE REP

United Health Care
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January 1995 to January 1997

* Successfully resolved a provider address issue to ensure claim payments mailed to correct address, affecting over 30 claims 
* Acted as resource within unit for Medicare and Medicaid claims adjudication processes for questions and procedure training 
* Gained problem resolution skills customer servicing claims questions 
* Successfully assisted plan members with Identification cards and Primary Care Physicans assignments upon request

ASSOCIATE APPROVER

MetraHealth
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January 1990 to January 1995

Handled the Medicare Secondary Payor project for our team. My supervisor selected me do to my accuracy in processing Medicare medical claims.

JUNIOR APPROVER

MET LIFE
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January 1984 to January 1990

* Customer servicing group health insurance claims. Worked 
my way up from Mail Clerk to Associate Approver under Met 
Life and Senior Service Representative under United 
Healthcare. 
* Successfully resolved a provider address issue to ensure 
claim payments mailed to correct address, affecting over  
30 claims 
* Specialized in the processing of Medicare and Medicaid 
claims, acting as resource and team “go to” and trainer on 
new processes and changes to Medicaid processing

MAIL CLERK I AND II

MET LIFE
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1983 to 1984

* Customer servicing group health insurance claims. Worked 
my way up from Mail Clerk to Associate Approver under Met 
Life and Senior Service Representative under United 
Healthcare. 
* Successfully resolved a provider address issue to ensure 
claim payments mailed to correct address, affecting over  
30 claims 
* Specialized in the processing of Medicare and Medicaid 
claims, acting as resource and team “go to” and trainer on 
new processes and changes to Medicaid processing

CLAIMS OPERATIONS ADMINISTRATOR

PEROT SYSTEMS HEALTHCARE/CSRG

* Processed a variety of medical insurance claims for several different clients 
* Utilized pricing lists, contracts and plan provision information to determine applicable plan benefits 
* Processed claim adjustments, reprocessing incorrectly paid claims and claims waiting for additional information that has been provided by insureds, providers or other insurance for benefit coordination.

Education

Sociology and Algebra

Milwaukee Area Technical College

January 2010 to January 2011

BSB in Accounting

University of Phoenix

January 2007 to January 2011

AA in Accounting

Axia College - University of Phoenix

January 2006 to January 2007

Certificate in Financial Clerk

Milwaukee Area Technical College -
Milwaukee, WI

January 1978 to January 1979

Skills

10 Key, Filing, Excel, Word, Windows, PowerPoint, Lotus Notes, Microsoft Office, Outlook, Quality, Customer Service, Problem Solving, Oracle, Rumba, Insurance Claims, Medicare, Medicaid, Medical Terminology, CPT, ICD-9, HCPCS, Claims Resolution, General Ledger, data entry, Citrix, FSA, US GAAP, Health Insurance, HIPAA, HMO, Journal Entries, Licensing, Online Research, administrative support, assembly language, call center, catalogs, customer relations, data entry, delivery, fax, file management, insurance, lotus notes, Microsoft excel, Microsoft mail, Microsoft outlook, Microsoft word, oracle, policy analysis, pricing, process engineering, quality, sales, scanners, spreadsheets, staffing, training

Certifications

Financial Clerk

May 1979

Group Life and Health Insurance / GLHIA

May 1988