Cheryl A. Palmer
Snellville, GA 30039
 [Send email to request phone number] 22-1372


JOB OBJECTIVE

To secure a position leveraging strong customer service and relationship
building skills while utilizing over 21 years of Health Care Insurance
experience.
  
                   
SUMMARY OF QUALIFICATION

* A talent for analyzing and resolving problems
* Good organizational skills & ability to work independently
* Flexible-willing to take on a variety of tasks
* Medical Terminology * ICD-9 * Revenue codes
* Strong motivation and dedication to job
* Strong communication, written and verbal correspondence skills
* Able to make important decision independently
* Self motivated
* Critical thinking skills
* Computer Literacy, including MS Word,PowerPoint, Lotus Notes, Facets network.
* Dedicated to highest quality work
* Attention to details.
* Maintains a quality assurance program to support the Total Performance
Management initiative and the consistent delivery of quality claims service. 
* Medical claims processing of Worker's Compensation, No fault, Subrogation,
Medicare, Managed Care, PPO claims 
* Customer Service and call Center experience
* Medical Adjustments
* Insurance Complaint and resolutions 
* Appeals and Grievances




PROFESSIONAL EXPERIENCE

04/87 - 08/08 Blue Cross & Blue Shield of WNY, Buffalo, New York

*Answer written and verbal inquiries, for claim review and disposition.
* Quoted contract benefits, enrollment eligibility, coordination of benefits,
referrals,
   to providers, participants, group representative, other insurance carriers,
outside agencies & vendors. 
* Performed online transactions such as real time claims adjudication for;
Medicare, Managed Care, Workers Compensation, No Fault and Subrogation Claims.
* Prepared appeals and reconciliation for contract holders.
* Identifies potential opportunities, problems, concerns, recommendations and
forward to management for further review.
* Identifies potential fraud cases and forward to Special Investigation
Department for further review.
* Investigate, evaluate and submit recommendations on complex coverage issues to
Corporate Claims.  
* Performs non-group enrollment activities and assists in new member
solicitation. 
* Handles executive and priority correspondence by researching the issues
involved and preparing a response.
* Assists subscribers in preparing claims for entry. 
* Adheres to call unit and plan to plan policies with regard to customer service
and patient confidentiality. 
* Analyzes trends and provide issues and strategies identify resolution. 
* Assisted in training and raised the level of employee performance and provide
constructive feedback through accurate assessment of staff performance. 
* Leads and participates in committees or special projects.


EDUCATION

AAS, Medical Office Secretary
Sawyer Business School, Buffalo, New York


AWARDS AND COMMUNITY SERVICE

Lydia T. Wright School of Excellence (Tutoring)
Breast Cancer Foundation-Susan B. Koman
Tour-De-Cure 
Junior Achievement Award
United Way
Reward & Recognition Management Award
Star Team Player Award
Concierge Customer Service Award
Blue Cross Blue Shield Volunteer Board of Directors Award
Certificate of Achievement Award
Junior Achievement Award
Total Quality Management Tools & Processes Award
The Lydia T Wright School of Excellence Award
Board of Directors Blue Crew Committee (Fund Raising)