Sharon Forrest

Experience

• 

  Prudential Insurance Company of America

  Sept 1985 - Oct 1986

  Claims Processor

  Entered claims data into the claims system Contacted physicians to confirm claims data by telephone and written correspondence.Adjudicated claims

• 

  Guardian Life Insurance Company of America - Central Ohio Agency

  Mar 1987 - Jul 1989

  Case Processor

  Reviewed documents from brokers for requirements necessary to complete the group application processActed as liaison between underwriting and the broker/agentMaintained the case to completionComplied and mailed completed policies to broker

• 

  Horizon Blue Cross Blue Shield of New Jersey

  Jul 1990 - now

  Oversees the creation of technical documents and high level solution designsOversees the development, testing and implementation of system specifications. Recommends best practices for delivering business solutions Acts as Subject Matter Expert in systems and technologies Facilitate business process analysis sessions with the client to identify business objectives, perform a needs analysis and gather business requirements.Provide analytical support to our internal customers and act as a liaison for IT regarding new system enhancements, and help to coordinate resources.Coordinate the development, testing, and implementation of system specifications Coding, building, testing and maintaining of the files in the claims systems.Ensured the validity of the files and related processing through interfacing with the Implementation team, Operations areas and various other departments including, Sales, Contract Development and On-Line BenefitsDeveloped and executed test cases to verify the system performs as designed and can support the business requirements Coded and updated benefits for new groups and existing groupsCreated monthly reports to track the coding of new groups and maintenance of existing groupsMaintained the Benefit Coding Database to ensure timely file loadingProvided external auditors with information necessary to audit the benefit filesInvestigated and resolved problem logs submitted by the business Documented job aids and workflows for the team Researched, designed, developed and maintained claims engine technical courseware policies and procedures for the implementation of each Line of Business Partnered with the Claims engine Business Process team to research and develop core technical training curricula, policies, and procedures for the insurance products. Conducted technical training to develop desired knowledge, skills, and behaviorsConducted audience analysis to assess prerequisite skills, learner characteristics, learning styles, delivery preferences and ability to apply new skills after training Contacted existing accounts to maintain positive relationsActed as the day-to-day contact for benefits personnel at the assigned account(s) to answer benefits inquiriesAttended open enrollment with the sales representative to explain benefits and claim actions Responded to verbal and written inquiries from members and providers regarding benefits, provider network, enrollment, correspondence, and claims processing.Resolved complex problems by researching and identifying underlying issues Processed complex claims, adjustments, and pends in accordance with Plan Policies procedures and contract provisions.Determined appropriate course of action, payment denial or if further investigation is required. Entered claims data and resolved pended claims in accordance with plan policies, procedures, and contract provisionsConducted additional research necessary to finalizing claims such as contacting members and providers to verify claim information.

  • Manager

    Apr 2023 - now

  • Senior Business Systems Analyst

    Jul 2016 - Oct 2023

  • Business Systems Analyst

    Jan 2007 - Jun 2016

  • Senior System Support File Analyst

    Jan 2005 - Dec 2006

  • Benefit File Specialist

    Apr 2004 - Dec 2005

  • Instructional Design Analyst

    Aug 2000 - Apr 2004

  • Senior Classroom Instructor

    May 1996 - Aug 2000

  • Account Consultant

    Apr 1995 - May 1996

  • Member Service Coordinator

    Oct 1994 - Apr 1995

  • Senior Claims Adjudicator

    May 1991 - Oct 1994

  • Claims Processor

    Jul 1990 - May 1991
• 

  United Way of Greater Newark

  Oct 2015 - Apr 2016

  Volunteer Tax Preparer

  Provide free tax preparation services under the Volunteer Income Tax Assistance (VITA) program to people who generally make $55,000 or less, persons with disabilities and limited English speakers.