Adewunmi (Carl) Y.

Adeyi
Email: carl.adeyi@bcbsfl.com

Summary
A focused career minded and business driven professional with extensive healthcare insurance knowledge in processing CMS1500, UB04 claim forms and customer service experience applying Ulysses strategies at all touch points, ability to work in a fast paced environment as a team or individual contributor. Work experience includes strong keying skills on Diamond claims, resolution of Quest inquiries, research skills in RBMS and Siebel to identify, document and resolve both claim and telephone inquiries at a First Contact resolution level, strong written and verbal communication skills, in addition to strong interpersonal, organizational and problem solving skills.

Education
Florida State College, Jacksonville Currently enrolled; Bachelors of Science degree program of Information Technology Management Current average GPA 3.5 Florida State College, Jacksonville Associates Degree of Art in Information Technology (Data Networking) Graduated Degree; August, 2012. Government College Lagos, Nigeria High School Diploma 1989 1995 Certifications Cisco Certified Network Administrator (CCNA)

Work Experience
Florida Blue State Account Operations 9/11 to present Claim Service Advocate III

Strong knowledge of claims processing system(keying of Professional 1500/UB04 Institutional with or without attachments ie: other insurance remittance, EOB and Medicare) Subscriber claims Outstanding ability in addressing web-based system issues experienced by member and providers and Triage of MyBlueService (MBS) inquiries Review and analyze BlueCard Host Claims and/or inquiries Review/ requesting of additional information from the providers or members to process claims and maintain the contractual deadlines. Ability to work assigned task and aged service requests independently with little to no assistance accurately following internal process guidelines while maintaining contract deadline

Excellent Research skills to include claim and non- claim issues (eligibility, NIA, managed care, authorizations, referrals, etc.) Provide constructive feedback and claim instruction to peers and other internal line of business areas. Contact Service Advocate III

State Account Operations

Handle inbound/outbound calls from members and providers to provide eligibility, interpret benefits (ICB), claims status, precertification, authorization, accumulator file for out of pocket, coordination of benefits etc. Knowledgeable ability to navigate research and verify necessary information within diamond, OPL (OCLI 9236) screens, Quest tools, CMCA web-based tool etc. Research, coordinate to resolution written and electronic inquiries to include claim exceptions Research/route clinical documents for Medical Review in a timely manner to resolve claim issues. Updating of members Other Party liability information via Siebel. Maintain and develop internal relationships with other lines of business to resolve issues Outstanding analytical skills to provide understanding of complex claim issues to callers Outstanding ability in addressing web-based system issues experienced by member and providers and Triage of MyBlueService (MBS) inquiries Research and Processing of written inquiries related to coordination of benefits, autoaccident, and workers compensation. Service Advocate II 5/2011 - 9/2011

Enrolment Membership & Billing

Handle both inbound and outbound calls from subscriber and providers Knowledgeable of Florida Blue products and services Enrolling new members and dependents into RBMS database. Productive use of IRP tools for premium quotes Excellent written and oral communication skills Support continuous improvement efforts through the identification of problems by communicating and coordinating with the appropriate contacts RBMS used to apply premium payments and other financial purposes via telephone Process member add-on request and update member contracts Productive use of Ulysses tools to Identify, probe to transition and satisfy the member

SAO (Incepture)

12/2009-2011 Claim Service Advocate

Strong knowledge of claims processing system(keying of Professional 1500/UB04 Institutional with or without attachments ie: other insurance remittance, EOB and Medicare) Subscriber claims Review and analyze BlueCard Host Claims and/or inquiries Ability to work assigned task and aged service requests independently with little to no assistance accurately following internal process guidelines while maintaining contract deadline Excellent Research skills to include claim and non- claim issues (eligibility, NIA, managed care, authorizations, referrals, etc.) Provide constructive feedback and claim instruction to peers WATTs calls to subscriber and providers to verify claim information to process claims

SKILLS Siebel, Diamond, PIP, ICB, EIP, APT, Quest, Imaginator, Client Letter, medical terminology, ICD-9, ICD-10, CPT coding, HCPCS, RBMS, Legacy, CMCA, ICB, RAD MD, PRIME, Claim XTEN and Availity tool. Proficient and Advanced level in Word, Excel and PowerPoint.