• Professional Experience
    2008 - Present
    •Director of the Corporate Services Team, Claim Team and Customer Care Team management and supervisory staff. •Large project management for new program implementations, including vendor implementations and software upgrades. Management of claim inventory and workflow assignments. •Oversee implementation, set up and testing of all new software programs prior to release within department. •Contract interpretation, including coordination of interpretation with Underwriting and/or Carrier.
    2008 - 2008
    •Responsibilities include all recruiting and contracting for West Coast Region.•Set up and implementation of all new provider contracts within region.•Review and determine provider eligibility for Express Health Services program.•Cold calling of prospective eligible providers for contracting.•Negotiation of rates and fees for prospective providers•Closing outstanding potential contracts within reasonable time.
    2007 - 2008
    •Responsibilities included management of all local marketing strategies, local advertising and public relations programs for two districts.•Prospected, planned, set up and executed all community events for both districts.•Planned, set up and presented all marketing presentations for local businesses and consumers.•Assisted District Office Managers with creation of individualized office marketing plans designed for surrounding communities.•Planned seasonal marketing strategy for all offices within both districts.•Trained local office staff for marketing methods, including business to business marketing mentoring.
    2007 - 2007
    •Responsibilities included all local marketing strategies, local advertising and public relations programs.•Prospected, planned, set up and executed all community events.•Planned, set up and presented all marketing presentations for local realtors.•Business to business sales of Amerispec’s home inspection services.•Reviewed and planned yearly marketing strategy.
    2001 - 2007
    •Managed Claim Department and Customer Service Department.•Monitored customer service calls for accuracy, efficiency and compliance with all HIPAA guidelines.•Created and maintained procedures and policies for the Claim and Customer Service departments.•Audited daily the claims processed by adjusters.•Implemented cost control vendor contracts and the managed the relationship with these vendors.•Reviewed and researched all member/provider appeals and rendered determination in accordance with contractual plan language.•Reviewed all financial reporting for accuracy and potential provider fraud.•Reviewed all potential subrogation files for submission to subrogation attorney. Served as liaison between our clients and the subrogation attorney.•Large volume of customer service via oral, telephonic and written communications with outside vendors & clients. •Special projects accomplished: programming, testing & implementation of HRA QicLink software program, medical coding auditing software and the implementation of cost control vendor contracts and daily management of the relationship with these vendors
    2001 - 2007
    •Implemented, planned and set up new contracted clients.•Served as sole liaison between clients and Self Insured Plans LLC Claim’s Department
    2000 - 2002
    •Managed several departments including Provider Relations Department, Recovery & Reimbursement Division and the Provider File Maintenance Department.•Answered and assisted employees with difficult situations or questions.•Reviewed and audited customer service phone calls for accuracy, level of service and efficiency. •Audited recovery & reimbursement coordinator’s phone calls and written correspondence for adherence to company policies. •Audited provider file maintenance employee’s completed work for accuracy.•Served as a liaison between Case Managers and Bill Review Department.•Served as contact person for worker’s compensation adjusters for clients managed by Bunch and Associates.
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