Loring Clark
Lexington
Summary
Experienced with managing and implementing system configurations to ensure optimal performance. Utilizes strong analytical skills and attention to detail to identify and rectify configuration issues. Knowledge of industry-standard tools and best practices for configuration management.
Overview
27
27
years of professional experience
Work History
Benefits Configuration Analyst
Leading Edge Administrators
01.2023 - Current
- Configure benefit plans in Javelina Claims System in accordance with group and ACA requirements.
- Perform release testing for upcoming system upgrades.
- Create and update claims adjudication and benefit cross reference tables to enable claims to process automatically.
- Maintain Master File Maintenance codes as needed.
- Ensured compliance with company standards by conducting thorough configuration audits.
- Provided timely support for end-users, resolving configuration-related issues quickly and effectively.
Senior Benefits Configuration Analyst
HealthSmart
11.2021 - 01.2023
- Configured benefit plans in QicLink Claims System.
- Assisted claims and customer service in resolving claim issues.
- Loaded provider fee schedules from individual networks or Medicare websites.
- Provided timely support for end-users, resolving configuration-related issues quickly and effectively.
- Designed and updated claims adjudication tables to enable claims to process automatically.
- Maintained miscellaneous system codes as needed.
- Created and maintained version description documents.
Senior Configuration Specialist
EBMS, Inc.
04.2018 - 11.2021
- Configured benefit plans in Javelina Claims System.
- Collaborated with cross-functional teams to ensure proper implementation of configuration changes.
- Enhanced system efficiency by identifying and resolving configuration issues.
- Compiled claim reports for Account Management to identify processing or payment errors.
- Assisted Plan Document team with new and existing Summary Plan Documents.
- Created and updated claims adjudication tables to enable claims to process automatically.
Billing Office Manager
Trans-Star Ambulance Service
01.2017 - 02.2018
- Enhanced team productivity by delegating tasks effectively and overseeing daily workflow.
- Initiated and renewed provider reimbursement contracts with networks such as WellCare, UHC and Humana.
- Compiled, approved, and maintained bi-weekly payroll records and personnel records.
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Improved team morale and cohesion with regular team-building activities and open communication channels.
Patient Account Representative
HealthScouts/Conifer Health Systems
09.2016 - 01.2017
- Responsible for follow-up and collections for 4 in-state hospitals.
- Communicated issues to management, including payer, system or escalated account issues and provided suggestions for resolution.
- Accurately and thoroughly documented all pertinent collection activity performed.
- Edited claims to meet and satisfy billing compliance guidelines for electronic submission.
- Maintained desk inventory, completed reports, and resolved high priority and aged inventory.
- Planned and attended meetings, training seminars and in-services to develop job knowledge.
Benefit Account Manager
KY League of Cities
04.2014 - 08.2016
- Licensed Health, Life, Property and Casualty Agent for the state of KY.
- Developed strategies to target new business opportunities
- Attended conferences and meetings to market services to potential clients.
- Developed strong client relationships with effective communication and personalized service.
- Assessed client needs regularly through detailed consultations, identifying areas where additional support or resources may be required to achieve desired outcomes.
- Coordinated open enrollment periods for multiple accounts simultaneously, ensuring smooth transitions between plan years.
Claims and Customer Service Supervisor
ARC Administrators LLC
11.2011 - 04.2014
- Assisted in the implementation of QicLink Claim system ensuring seamless integration with existing infrastructure through careful configuration planning.
- Coached employees through day-to-day work and complex problems.
- Enhanced team productivity through regular coaching, feedback, and performance evaluations.
- Improved customer satisfaction by addressing and resolving escalated issues promptly and professionally.
- Generated financial reports for monthly claims usage.
- Maintained Summary Plan Documents for new and existing clients.
- Audited claims for financial accuracy to ensure 98% accuracy rate.
- Created and maintained provider contracts and fee schedules.
Benefit Plan Analyst
UMR – United Healthcare
06.1998 - 11.2011
- Assisted in the implementation of QicLink Claim system ensuring seamless integration with existing infrastructure through careful configuration planning.
- Set up system for automatic claims processing achieving a 46% automated first pass rate.
- Audited claims for financial accuracy to ensure 97% accuracy rate.
- Assisted with training claims processors and customer service representatives.
- Generated financial reports for monthly claims usage.
- Maintained provider contracts and fee schedules for both physicians and facilities.
- Worked with claims and customer service to resolve provider payment disputes.
- Created and maintained Summary Plan Documents as needed.
Education
Bachelor of Science - Management
Indiana Wesleyan University
05.2010
Skills
- Benefit configuration
- Claims processing
- Software System Testing
- Problem-Solving Expertise
- Interdepartmental Cooperation
- Critical Analysis
Timeline
Benefits Configuration Analyst
Leading Edge Administrators
01.2023 - Current
Senior Benefits Configuration Analyst
HealthSmart
11.2021 - 01.2023
Senior Configuration Specialist
EBMS, Inc.
04.2018 - 11.2021
Billing Office Manager
Trans-Star Ambulance Service
01.2017 - 02.2018
Patient Account Representative
HealthScouts/Conifer Health Systems
09.2016 - 01.2017
Benefit Account Manager
KY League of Cities
04.2014 - 08.2016
Claims and Customer Service Supervisor
ARC Administrators LLC
11.2011 - 04.2014
Benefit Plan Analyst
UMR – United Healthcare
06.1998 - 11.2011
Bachelor of Science - Management
Indiana Wesleyan University
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