TANYA L.

KNIGHT
tkb07c66@westpost.net 735 Auburn Street Whitman, MA. 02382 781-523-1836

BENEMAX, INC.
2008 - 2010
Assistant Claims Manager Medfield, MA
Analyzed and processed medical, dental, and RX claims in an accurate and timely
manner based on plan policy provisions
Acted as a secondary payer while adjudicating self funded claims
Requested all necessary information to make claims payment determination
Worked closely with the customer service department to expedite various claims
Answered claims calls from providers, members, and contract liaisons
Provided hands on support to staff members by being readily available to answe
r questions as needed to ensure proper claims processing
Managed the Quality Control Process of the claims and customer service departme
nts by systematically auditing paid and pended claims according to policy guidel
ines
Analyzed results and identified areas for process and quality improvement while
providing feedback to processors
Assisted in the development of strategies and evaluated opportunities to increa
se processor performance (production, quality, etc.)
Communicated audited results to individual processors as well as senior managem
ent
Led various ad-hoc claims projects
Collaborated with the Claims Manager in the daily operational oversight of the
claims department supporting the processors to achieve corporate goals and objec
tives
Performed all initial training to newly hired claims processors
Helped identify the need for ongoing training and development of policy, proced
ures, and job-aids to aid processors on all types of claims
GUARDIAN LIFE INSURANCE COMPANY OF AMERICA
1990 - 2008

Medical Review Administrative Assistant Boston, MA

Coordinated peer review referrals based on recommendation of the review nurse
Communicated via correspondence or directly with provider/designees when approp
riate to gather all clinical information required to determine the medical neces
sity of healthcare services
Assisted in the interpretation of insurance coding, while utilizing the knowled
ge of resources including CPT and ICD-9 codes
Monitored medical and surgical invoices for over-utilization, excessive charges
, and/or units, inappropriate billing practices
Served as the medical resource liaison to the claims staff
Communicated all review outcomes to providers and/or claims staff
Maintained the privacy and confidentiality of information, acting with ethics a
nd integrity, and adhering to applicable federal, state, and local laws and regu
lations
First Level Appeal Specialist
Reconciled provider and insured appeals based on plan policy provisions
Identified and communicated appeal results, adjusted claims, prepared determina
tion letters, and documented the accounts appropriately based on the results of
the appeals
Coordinated escalated level appeals consistent with company guidelines
IV Therapy/Chemotherapy Case Manager
Managed high level cases regarding IVT and chemotherapy clients
Collaborated with healthcare vendors to facilitate appropriate client care, bas
ed on medical necessity
 Employed cost effective treatment, while diligently tracking cost savings

TANYA L. KNIGHT PAGE TWO

Medical Claims Approver

Adjudicated both fully and self insured claims based on HIPAA regulations
Processed claims accurately and timely, according to company guidelines
Customer Service Representative
Aided providers and insureds with both claims and benefit determinations
As a member of a high volume call center, analyzed and resolved provider and in
sured issues
Provided both proactive and reactive customer service
Mail Room Clerk/Microfilm Department
Opened, sorted, and distributed incoming mail and packages to the appropriate d
epartments
Catalogued all completed work folders

EDUCATION, ETC.
High School Diploma
Silver Lake Regional High School Pembroke, MA
Computer Skills
Claimfacts Medical Processing System, Microsoft Office (Outlook,
Word, Powerpoint, Excel),
Lotus Notes, Siebel, Sharepoint, RIMS, PayDirect
References
Available Upon Request