SIAN SMITH

P.O. Box 1163 * Owasso, OK 74055 * (918) 261-2755 * ssmith773@gmail.com

Results-driven professional eager to offer proven Healthcare and Financial Servi
ces industries' experience,
including strong talents in Medical Claims Processing, Strategic Analysis / Plan
ning, Quality Assurance, Regulatory Compliance, and Client Relations, toward max
imizing an employer's success within a key role.
PROFILE OF QUALIFICATIONS
* Out-of-the-box thinker who demonstrates knowledge of medical claims processing
, financial services, and investment planning, including offering talents in str
ategically analyzing a high-volume of data to meet and / or exceed objectives.
* Ambitious self-starter who contributes superior attention-to-detail and strong
problem-solving skills while working among HMOs, PPOs, POS, and Medicare, and l
iaising between countless providers in alignment with healthcare goals.
* Conversationally proficient in Spanish and Italian languages; able to clear ri
gorous background checks.
PROFESSIONAL SYNOPSIS
Customer Service Representative (Contract Position)
BROADPATH HEALTHCARE SOLUTIONS (TUFTS HEALTH PLAN), BOSTON, MA 2010 - PRESENT
* Utilize broad scope of medical industry knowledge and dynamic business acumen
toward serving as a forward-thinking Medicare HMO and Medical Supplement Represe
ntative, including providing wide-ranging benefits, pharmacy, and plan informati
on to individuals, as well as upholding solid customer service which is instrume
ntal in driving operations success.
Quality Assurance Auditor (Contract Position)
BROADPATH HEALTHCARE SOLUTIONS (CIGNA HEALTHCARE), NASHVILLE, TN / DENISON, TX 2
009 - 2010
* Contributed sharp analytical abilities toward performing face-to-face audits,
including auditing Customer Service Representatives for Medicare-based quality,
handling benefits and pharmacy efforts, and serving as a Medicare back up.
Medical Claims Specialist / Customer Service Representative (Contract Position)
PEROT SYSTEMS, INC. (BLUE CROSS BLUE SHIELD), PLANO, TX 2008 - 2009
* Demonstrated comprehensive medical claims processing knowledge, strong custome
r service, and proven technical proficiencies toward providing claim and eligibi
lity information while handling national accounts among several regions.
* Liaised among HMOs, PPOs, POS, and Medicare to handle contract issues, claims
correspondence, and problem resolutions, along with communicating claims status,
updates, resolutions, and payments to hundreds of providers daily.
* Facilitated detailed documentation for each account with AIMS, WGS, Imaging, C
allCare, Mainframe, and other systems.
* Recognized for job performance as the only employee to receive two consecutive
accolades from a special recognition board.
Medical Insurance Claims Processor / Customer Service Representative
WISCONSIN PHYSICIAN SERVICES, MADISON, WI 2004 - 2005
* Applied excellent communication and interpersonal relations talents toward ass
isting callers and providers with questions regarding health benefits as contrac
ted by the government, along with supporting operations with a third party liabi
lity area whereas responsibilities included reviewing, researching, approving, a
nd processing legitimate third party liability claims.
Trust & Estate Planning Specialist
ROBERT W. BAIRD, INC., MILWAUKEE, WI 2001 - 2002
* Strategically steered trust and estate planning for high net worth clientele w
ithin a Wealth Management Division, including preparing and entering all financi
al and personal data into complex systems; calculating net worth, assets, and di
verse other information to create effective estate plans; and assisting attorney
s with trust documentation as required.
SONORA SMITH
(918) 261-2755 * Page Two * ssmith773@gmail.com
PROFESSIONAL SYNOPSIS (CONTINUED)
Retirement Plan Coordinator / Administrative Assistant
STRONG CAPITAL MANAGEMENT, INC., MENOMONEE FALLS, WI 1998 - 2001
* Coordinated 401(k) plans within a Retirement Plan Services Division, including
working among 15 varying technical systems to extract, process, and reconcile 4
01(k) payroll data, as well as maintaining large-scale recordkeeping systems.
* Ensured seamless processes and regulatory compliance by assisting a Director o
f Client Services, three Relationship Managers, and Compliance and Conversion Sp
ecialists in drafting correspondence, creating spreadsheets and presentations, u
pdating sales and marketing databases, organizing expense reports, and composing
kits for client visits.
EDUCATION & TECHNICAL SUMMARY
Bachelor of Arts in International Studies, Communications, & Political Science
~ Triple Major, Projected Fall 2011 ~
UNIVERSITY OF WISCONSIN-MADISON
Microsoft Office Suite * Microsoft FrontPage * Avaya CMS Supervisor * CMS Websit
e * CallCare * WGS
Argus Pharmacy System * Medicare-Specific Systems * IBM Lotus Sametime Connect *
PADS * eTalk * Access Online
ORT * WebChannel * Diamond * Mainframe * Macess * Caremark Pharmacy * CCMS * Ful
fillment * Lotus Notes * Modems
Epitome * Notepad * QNXT * FileNet * CenterView * Silent Observe * IEX * Blue Sq
uare * PeopleSafe * Metavante * TAPS