Mark T. Hahn
1710 Callone Avenue
Bethlehem, PA 18017-4134
Phone - 484-719-2540 E-Mail- firstname.lastname@example.org
To expand my overall learning and business experience in order to make a successful viable contribution to a progressive organization serving the organization’s mission statement and becoming a more valuable asset employee utilizing my extensive educational and business experience with commitment and service excellence to all internal customers, external customers providers and stakeholders.
Provider Customer Service Professional – March, 2013 to Present – Aetna – Allentown, PA
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors.
Explains member's rights and responsibilities in accordance with contract.
Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits.
Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits.
Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary.
Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Customer Service Representative – July, 2012-December, 2012 - Aerotek-An Allegis Group Company, Bethlehem, PA
Previously employed as a contract employee working within a large insurance company providing benefit information to its membership; educating the membership on policy information and the various products and services available to them. Effectively and actively working to retain membership within the organization and outside the organization to effectively grow the organizations membership base; This includes the selling of organizational memberships; Also continue to promote the sale of the organizations products and services through the education of its membership by telephone inquiries.
Associate - April, 2011-April, 2012 FISERV Dublin, OH
Have worked in customer care area applying a wide range of information as it relates to the financial credit card services industry for 16,000 clients worldwide; Responsible for the activations of various types of credit cards as well as investigating fraud and abuse which occurs in the industry. Utilize various company software platforms to facilitate all clients and financial institutions; Responsible for maintaining client confidentiality as well as company proprietary information.
Claims Examiner - 2005-2010 - HIP Health Plan New York New York, NY
Absorb, retain and effectively apply a wide range of information about HIP policy, order of benefit determination as applicable within a claim processing environment utilizing established industry guidelines.
Consistently review and investigate claims as related to Facility Hospitals and providers in a timely and efficient environment in a production environment.
Examine claims processed to ensure that the appropriate action has been taken to identify and ensure timely and accurate payment utilizing all HIP claims system information based upon procedural, payment and financial accuracy, based on established and industry recognized goals and guidelines.
Knowledge of various claims processing systems which includes claims adjudication systems and inquiry systems as well as corporate web based (Customer Service System)
Proactively participated and contributed ideas and possible solutions to enhance streamlined claims processing to all levels of management.
Consistently demonstrated an eagerness for continued growth and learning and contribution within the department to all levels of management.
Actively assisted the department in the resolution of complex facility claims as it relates to our members and providers related to timely grievance and appeal issues at the request of direct management.
Presented recommendations, suggestions and ideas with respect to the betterment of claims auditing tracking implementations and procedures to direct management at all levels.
Senior Customer Service Advocate - 1995- 2005 HIP Health Plan New York New York, NY
Trained and oriented new employees in all areas of HIP contracts, policy and procedure and customer service skills.
Investigate, analyze and resolve complex subscriber and provider queries and complaints by telephone, in writing, and in person.
Functioned as a liaison between HIP customers, and medical providers (doctors, hospital administrators and other medical professionals), clarifying HIP benefit information and members’ coverage on all HIP lines of business.
Interacted with employee benefits officers of contract companies.
Identified potential problems to HIP management, make recommendations and suggest solutions to recognized problems.
Assisted other HIP departments on special projects at the recommendation of management (claims) in an effort to reduce inventories for better efficiency.
Member Services Representative - 1992-1995 HIP Health Plan New York New York, NY
Responded to routine subscriber queries and complaints.
Followed up to ascertain that issues were properly being resolved.
Made recommendations to HIP management to aid service excellence and improvement.
Assisted in the development of various incentive programs for customer service representatives and participated in company wide focus groups in an effort to improve the HIP system of delivery.
Accounts Payable, Finance Department - 1990-1992 HIP Health Plan New York
Coordinated processing of all vendor bills and invoices.
Processed HIP emergency service personnel payroll.
Assisted in all other accounting functions wherever needed.
Currently Attending- DeSales University-MSIS Program Healthcare Center Valley, PA
Bernard M. Baruch College - City University of New York-2004-MS, Industrial and Labor Relations (Honors)
Bernard M. Baruch College - City University of New York 1997-BBA, Human Resources Management (Honors)
LaGuardia Community College - City University of New York 1989-AS, Business Administration (High Honors)
Sigma Alpha Delta Honor Society, Bernard M. Baruch College, City University of New York, 1997-present
Bernard M. Baruch College, City University of New York Alumni Association, 2004-present
Six Sigma Training Program (Yellow Belt), 2010-present
Lehigh Valley Amateur Astronomical Society, 2012-2015
Knights of Columbus,
Sacred Heart Church of Jesus Roman Catholic Church Bethlehem, PA-Charter Council Member, 2013
Current member and officer of Thomas B. Welsh; Assembly 931 Knights of Columbus , Allentown, PA, 2014 Color Corp Member, 2014
Holy Name Society, Bethlehem PA Chapter, Sacred Heart of Jesus Roman Catholic Church
Lector-Sacred Heart of Jesus Roman Catholic Church, Bethlehem PA 18020
Owner - 1998-2001 Four Star Video, Staten Island, NY - (In conjunction with working a full-time professional corporate position.)
Owned and operated originally opened in 1985 consisting of Video rentals DVD movie rentals and video games serving the Staten Island, New York City community.
Assisted in the day-to-day decision-making and management of 3 employees.