35650 Grand River
Farmington, Mi 48335 Phone [Send email to request phone number] 87-0439
Email: [Send email using form at bottom]
Penny Carpenter
Objective To join a team environment that capitalizes on my analytical,
organizational, communication and technical skills gained through over 25 years
of experience.
Experience November 2008 to April 09 Ameraplan, Inc. Troy Mi
Claim Supervisor for TPA
• Managed claim examiners
• Handled refunds, reporting, group assignments
• Developed training and ongoing education of examiners
• Audited claims
• Handled escalated phone calls and other issues
• Handled reinsurance claims
• Weekly reporting of production, backlog and other issues to upper management
• WLT Claims system
September 2006 to November 2008 Protective Life Corporation Bannockburn, Il
Administrative Supervisor, Quality Assurance, Compliance & Training Credit Life
and Disability
• Hired as Quality Assurance & Training promoted within 6 months
• Supervise Claim Assistants and phones have brought dropped calls to lest than
1%
• Developed and trained both claim assistants and examiners
• Developed a training manual with step by step instructions on use of claims
systems & procedures
• Assist with internal and external audits
• Developed auditing standards, procedures, reporting results to management
staff
• Reply and process claims for Market Conduct inquiries
• Understand and apply Certificate language
• Access Based Claims Payment System
• Ensure compliance with State regulations
• Identify and provide ongoing training for all Credit Claims Staff
• Implement processes and internal controls for claim adjudication standards
May 2005 to September 2006 Westlake Financial Group, Inc
Buffalo Grove, Il
Manager of Administrative Services
• Responsibilities include supervision and management of FSA, COBRA, TPA
• Training for customer service and claims staff
• Client meetings and presentations
• Reporting
• Problem solving and staff development
• Interviewing, employee performance evaluation, hiring
• Implementing electronic data interchange claims receipt through setting up
relationships with new clearing houses
• New Client Implementation including banking, plan language development and
clarification, writing Plan Document and Summary Plan Description
• Responsible for writing SPD’s for existing and new clients
• HIPPA Compliance Manager for entire office
• Claims Payment System FACTS
2000-May 2005 Allied Benefit Systems, Inc Chicago, Il
Auditor/Trainer/Claims Examiner/Special Projects
• Developed new strategy for building plans in system for automation
• Set up plans under new plan design added groups to automation process
• Made recommendation for plan changes for clients
• Assisted Plan Building department with implementing new plan design
• Trained existing plan building staff on new open plan design
• Developed training manual and training program for claims staff and customer
service representatives.
• Responsible for examiner training
• Assisted with medical review for claims requiring more technical expertise
• Paid claims as an examiner to continue to enhance skills as trainer and
auditor
• Reviewed claim appeals, approved or wrote denials
• Claims payment system RIMS
1990-2000 Benefit Administrative Systems Homewood, Il
PPO Department 10/99 – 8/2000
• Identified and offered solutions to contract problems, resolved discount
disputes
• Handled high dollar out of network claims and negotiated discounts
• Wrote letters to providers regarding disputed PPO discounts
• Claims payment system RIMS
1990-2000 Benefit Administrative Systems Homewood, Il
Plan Builder and Interim Claims Supervisor 9/97 – 10/1999
• Reviewed plan documents for new companies, built plans in system
• Developed plan sheets for claims staff for quick overview of benefits
• Handled all claim adjustment corrections
• Claims Payment system RIMS
1990-2000 Benefit Administrative Systems Homewood, Il
Trainer/Auditor 9/93 – 9/97
• Developed and implemented claims examiner training
• Handled claim adjustment, refunds and voids
• Printed claim checks through claims payment system
• Responsible for provider additions and provider file correction
• Assisted with New Client Implementation, history accumulators loads
• Paid claims as needed added providers
• Claims Payment System Rims
1990-2000 Benefit Administrative Systems
Homewood, Il
Claims Examiner 4/90 – 9/93
• Paid medical, dental, short term disability and vision claims
• Handled customer service calls and resolution of problems
• Paid multiple accounts
• Claims Payment System RIMS
2/89-4/90 Gallagher Basset
Glen Ellyn, Il
Claims Examiner
• Successfully and accurately processed claims for various accounts
• Claims Payment system ERISCO
10/88-2/89 Allstate Insurance
Rolling Meadows, Il
• Successfully and accurately processed claims for Retiree Unit
10/87-10/88 Loyola Medical Center
Maywood, Il
Unit Secretary
• Responsible for communications with staff and families in trauma unit
• Updated patient charts
• Accurately transcribed physicians orders
9/86 – 9/87 American Community Insurance
* Call center representative
Education 1980 Marygrove College Detroit, Mi
• Medical Terminology
• Anatomy & Physiology
1977-1980 Oakland Community College Farmington
Hills, Mi
Varied Liberal Arts courses
Interests Writing, music, sports and entertainment
|
