Elizabeth A. Vaughn9525 Arrowridge DriveLouisville, KY 40229

Home Phone (502)742-4475

SUMMARYI am a strong leader and am very adept to multi-task situations. I have great organizational skills and can easily get along with co-workers. I often rise to the top level of every job and am certain to get the job done. I have an excellent attendance record and am very reliable when needed to give the extra effort to complete all tasks assigned to me. As a leader of a team of 11 associates I am focused on the overall goals of the team as well as engagement among those who work from home. My objective is to pursue a career in higher management for my current organization.

WORK HISTORY

2014-2015 IT Business Consultant – Core Platform ServicesResponsibilities include assisting IT applications engineers and consultants with understanding the needs of the business as related to updates to CAS claims processes. I also served as a liaison between the IT representatives and the business representatives in making sure each understood the other’s intent as related to Clarity projects. Assisted in writing requirements for projects and identifying areas affected by changes taking place on the CAS platform.

2010-2014 Front Line Leader –Financial Recovery Special ProjectsResponsibilities include overseeing the day to day activities of a team of more than 10 associates both in the office and work at home. I am also responsible for managing the inventory for my region consisting of 16 states. I attend weekly and monthly calls with our markets where the inventory and prioritization requests are resolved. I continue to support the roles of the associates on my team when they are out of the office in order to maintain minimal aging of projects.

2007 – 2010 Financial Recovery Special Projects CoordinatorResponsibilities include writing projects as submitted from the market, PSR, Plan Load, Product Build, and Provider Contracting after various system updates are implemented. I am also responsible for maintaining a special projects database where other departments such as customer service and CRU send e-forms for projects. I am responsible for creating IPARs from this database as well as keeping in touch with the submitter for project status. I am an active participant in weekly conference calls for our market and currently organize writer calls within our department to ensure consistency among the different regions. Since I started in this role I have also organized IPAR submission training classes for the departments listed above.

2006-2007 Financial Recovery Special Projects SpecialistResponsibilities include reprocessing of claims on projects due to contract and/or benefit updates while providing clear feedback in the comments on an Excel spreadsheet. I learned the MTV claims processing procedures while in this role and was able to work and complete projects on both CAS and MTV. Extensive knowledge of both CAS and CIS contract loads was required to ensure proper payment on claims.

2005-2006 Customer Service Team LeadResponsibilities include guiding Humana Customer Service Reps when necessary to ensure they are able to offer the best possible service to their caller. Also responsible for managing my team in the absence of our supervisor. Responsible for training as well as huddles when new policies or procedures are put into effect. I also perform a monthly side by side with each rep to provide them feedback on their performance. In addition, I am responsible for review of quality evaluations and team metrics for my supervisor. I have also assisted both our correspondence department and our CRU department with reprocessing claims for the last two years. This includes reprocessing denied claims as well as making adjustments to claims that have been paid incorrectly. This requires extensive knowledge of verification of provider contracts as well as member benefits.

2003-2005 Customer Service Claims Specialist, Humana Inc

Responsibilities include offering guidance to customers regarding their health care plan as well as answering questions they may have about their benefits and processed claims. Also responsible for assisting providers with benefit and claim questions with respect to Humana members.

EDUCATION1991-1995 General, Seneca High School1995-2000 Bachelor of Arts in Psychology, University of Kentucky

Bachelor of Arts in Sociology, University of Kentucky

Computer SkillsMicrosoft Excel, Word, Works, PowerPoint, Office, Outlook, Access