JAMIE WILSON
Columbia,SC
Summary
Experienced Benefit Files Analyst with a strong background in healthcare administration and information systems. Proven ability to manage teams, streamline processes, and ensure compliance with industry standards and security. Skilled in insurance contracts, underwriting, data analysis, cross-departmental coordination and technical support.
Overview
15
15
years of professional experience
Work History
Benefit Files Analyst II (BlueChoice Operations)
BlueCross BlueShield of SC
05.2018 - Current
- Evaluates interrelationships between applications to determine how benefits should be programmed within the system.
- Coordinates with all lines of business on development, set up and testing of new and existing benefit structures and rules.
- Identifies and resolves system related issues.
- Mentors other analysts to interpret, analyze, and document solutions to meet plan design specifications.
- Creates, and updates benefit information for RULES database used for verification of benefits.
- Facilitate the development of benefit data to ensure accuracy for claim adjudication.
- Identifies codes in the system that details groups effective, term, and reinstatement status.
- Coordinate the Blue Option benefit line of business for annual updates to benefits along with newly acquired and discontinuation of plan designs.
- Navigate several job specific information systems such as CES, PIRS, BDS, PEMU, RNAR, and GTMU for reinstatement, activation of benefits, cancellations, and billing of policies.
- Performed quality control checks of peers' daily operations to ensure compliance and quality standards are met.
- Prioritizes work requirements to meet deadlines and facilitate tasks to team members.
Membership Analyst (Books and Contracts)
BlueCross BlueShield of SC
04.2015 - 05.2018
- Coordinate with management, contract compliance and marketing department to ensure group, marketing and management requests are met in an accurate and timely manner to meet strict deadlines.
- Ensure interdepartmental procedures and systems are utilized for document compliance.
- Maintain and update tracking on a daily and weekly basis to ensure management has access to accurate documents.
- Train new analysts to adhere to department procedures and quality standards.
- Coordinate and distribute tasks to analysts’ workloads based on priority and analyst expertise.
- Supports management by completing special projects to improve departmental processes.
- Construct Health and/or Dental benefit books and contracts using custom software with efficiency and average accuracy of at least 97%.
- Research group files for custom benefits and verbiage unique to specific groups benefits.
Provider Contract Coordinator
BlueCross BlueShield, Planned Administrators, Inc. (PAI)
01.2011 - 04.2015
- Maintains provider's account details including addresses, tax id numbers, and specialty information within RIMS database.
- Coordinates with customer service team to ensure timely claims processing (cross trained utilizing AMMS).
- Responds to telephone calls and correspondence from providers for claims information.
- Operate SDS-Quick Claim system to view and input claim information into RIMS database.
- Operate Tax Port Convey system to verify providers and tax identification numbers.
- Facilitate training of new employees to ensure new employees were up to date with departmental standards.
Education
Master of Science -
University of Phoenix
Phoenix, AZ01.2023
Bachelor of Science - Health Care Administration
University of Phoenix
Phoenix, AZ01.2013
Associate of Science - Computer Technology
Central Carolina Technical College
Sumter, SC01.2006
Skills
- Analytical thinking
- Communication
- Time management
- Project management
- Quality Control
- System Testing and Evaluation
- Database Management
- Advanced Excel Reporting
- Microsoft office Suite
- Team Leadership
- Attention to Detail
- Technical Support
- Training and Mentoring
- Process Improvement
Timeline
Benefit Files Analyst II (BlueChoice Operations)
BlueCross BlueShield of SC
05.2018 - Current
Membership Analyst (Books and Contracts)
BlueCross BlueShield of SC
04.2015 - 05.2018
Provider Contract Coordinator
BlueCross BlueShield, Planned Administrators, Inc. (PAI)
01.2011 - 04.2015
Master of Science -
University of Phoenix
Bachelor of Science - Health Care Administration
University of Phoenix
Associate of Science - Computer Technology
Central Carolina Technical College
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