1. Jacqueline J. Tiettmeyer
1019 Highland Avenue
Ft. Thomas, KY 41075
(513) 265-9273
jjt4802@yahoo.com
Professional Summary:
Competent Insurance and Medical Claims Specialist with the ability to manage claims for several
states. Provides excellent customer service to all clients. Hard-working and organized with a solid
background in organizational development.
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Skills:
Knowledge of Microsoft Office Programs Self-starter with a professional manner
30+ years in Insurance Claims Strong attention to detail
20+ years in customer service Excellent Communication Skills
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Work History:
Humana, Inc. Cincinnati, OH 1999 – 2015
Grievance and Appeals Specialist 2005 – Present
 Assess and resolve member and provider appeals within rights of member per
employer group benefit design and confines of state and federalregulations.
 Align work effort to drive resolution with internal and externalpartners including
claims processing, medical reviews and provider relationships.
Claims Rework Unit MTV Platform 2004 – 2005
 Reviewed claims for appropriateness of applied benefits
 Reworked the incorrectly processed claims. Selected first in the Cincinnati
Service Center to process in this claim’s paying system.
Critical Inquiry Unit – Cincinnati Service Center 2003 – 2004
 Reviewed and processed subpoena request.
 Assessed and resolved inquiries sent to Humana executives within a timely
manner.
 Responded to Department of Insurance inquiries from the states of Ohio,
Kentucky and Indiana within the appropriate time frame.
 Reprocessed claims for the Grievance and Appeals department upon their
request.
Claims Unit – Cincinnati Service Center 2002 - 2003
 Generated reports for all claims processed for members who had services
provided in the states of New York and Massachusetts.
 Calculated the surcharge to be sent to the states that helped cover their indigent
care services.
Financial Recovery Unit – Cincinnati Service Center 2000-2001
 Reviewed processed claims for possible overpayment made to providers.

2.  Went to hospitals for on-sight review of medical charts to correctly process claim
submissions.
Claims Rework Unit ChoiceCare Platform 1999 – 2000
 Reviewed claims for appropriateness of applied benefits on the ChoiceCare
System in the Coordination of Benefits unit.
 Reworked claims if they were processed incorrectly.
 Investigated for primary verses secondary carrier.
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Education:
High School Diploma
Newport High School- Newport, KY
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Awards and Certifications:
2009 Shining Star Award
Recognizing an issue that was causing claims for a self-funded group to pay incorrectly
2011 Shining Star Award
Recognizing process improvement for a self-funded group to make their appeal process
more employee friendly
2013 Brand Character Award
Assisting a self-funded group with a claim history review of 77 claims which 25 resulted
in additional payments
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References:
Available on request