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Paul T. Mason1916 R Street, NW Apt # 104Washington, DC 20009-1019
Summary of QualificationsExtensive experience in Health Insurance and related fields
Articulate, effective communicator: adept at connecting and interfacing at all levelsWell organized: proficient at successfully managing multiple projects/task simultaneously
Highly oriented to service quality and customer satisfaction
EducationJunior College of Albany 1974 – 1975Albany, New YorkAverett College - Danville, Virginia - Took some college course 1997
Professional Experience
CareFirst Blue Cross and Blue Shield 2007 - 2015Washington, D. C. 20065 1998 – 2005Senior Software Testing Engineer
Ensure the accuracy and integrity of assigned systems through the developments and execution of efficient test plans and the documentation and resolution of testing problems as they arise. Responsible for testing the system’s business and functionality with established procedures to ensure that corporate standards and end-user requirements are being met. Provides analysis and testing support for current and future business initiatives. Analyzes and tests system programs to assure that system integrity is not compromised. Acts as a technical and business representative for internal and external customers for system related questions, problems and their resolution. Position was eliminated July 2015.
CareFirst Blue Cross and Blue Shield 2005 - 2007Washington, D. C. 20065Provider Service Representative
Handled phone inquiries and written correspondence for all lines of business. Process claims and adjustments for proper adjudication. Assist department managers on special projects.
CareFirst Blue Cross and Blue Shield 1996 - 1998Washington, D. C. 20065Network Provider Specialist/Credentialing Specialist
Create and maintain provider fields, handle credentialing and pre-screening of providers for participation with CareFirst, Inc. and affiliated networks for all lines of business. Enter and update provider’s information via the computer systems. Handle phone inquiries and correspondence.
Prepare credentialing application and contracts to providers and follow up with providers for any questions on credentialing application and the preparation of the credentialing process.
Humana Health Care Plans 1993 – 1996Tampa, Florida 33609 Customer Service Representative/Pasco County Sheriff Office on Site Representative
Handled phone inquiries on our HMO policy and procedures, document quality of service issues and care rendered by the physician and other health care providers. I was selected to be the on-site Representative for the Pasco County Sheriff’s Office; responsible for resolving immediate problems.
The Travelers 1991 – 1993Rocky PointTampa, Florida 33610Customer Service Representatives/Intake Coordinator
Handled phone inquiries and correspondence related to the GTE contract. Processed medical claims for proper adjudication. I was the Intake Coordinator; my duties included handling phone inquiries and obtaining medical demographics from Hospitals and Providers offices for appropriate hospital setting and pre authorization.
Blue Cross and Blue Shield of Northeastern New York/Albany 1975 - 1985Health Options of Central Florida /Orlando, Florida 32869 1985 – 1987Subsidiary of Jacksonville, Blue Cross and Blue ShieldEmpire Blue Cross and Blue Shield/Albany, New York 12211 1987 – 1991(Held various positions)Customer Service Representative/Trainer/Provider Service Representative
Liaison for Empire Blue Cross and Blue Shield and the New York State Department of Civil Service Health Insurance, and their Participating State Agencies. Handled and resolved customer inquiries. Customer Service Representatives trainer. Other duties included handling of problems as the liaison for the other Blue Cross and Blue Shields Plans within New York State. Received a letter of commendation from the Presidents of Empire Blue Cross and Blue Shield.
Received highest CSR Evaluations. Represented Blue Cross and Blue Shield in a New York State AD Campaign, my picture was featured in local business papers, bill boards, and the U.S. News and World Report/ October 1989
Direct Payment Reconciler for the accounting department at Empire Blue Cross and Blue Shield, my duties included, monthly reconciliation, performed general accounting functions and duties. Resolved customer inquiries, processed accounting transactions via computer
Health Options of Central Florida/Senior Claims Examiner/Provider Representative
As the Senior Examiner, my duties included the processing and analyzing medical claims for proper adjudication for Health Options.
As a Provider Representative, my duties included going out to our participating providers and orientated providers on our HMO policy and procedures, acted as a liaison for the provider’s office and Health Options of Central Florida.
