1. Brenda Meluh-Williams
3325 Brewster Court
Manchester, Maryland 21102
bmwcew@gmail.com
Home (410) 374-1199
Mobile (410) 917-3044
SUMMARY: An experienced healthcare professionalwith a diverse background in medical insurance claims
processing and adjustments,training and auditing. Over twenty-five (25) years of comprehensive
knowledge with the ability to balance business needs and customerdemands.
 Excellent communication skills (written/oral)  Computer literate
 Skilled in community underwriting  Good interpersonal skills
 Outstanding analytical qualities  Planning and scheduling
PROFESSIONAL
EXPERIENCE: TRIZETTO Corporation, Linthicum, MD (1995 – present)
Senior Adjustment Coordinator and Subject Matter Expert 1999 – present
Adjust claims as per the request from Customer Service, Provider Relations, and Claims
Departments. This position is an integral part of the Operations sectorof the company; whereby
audits and quality are monitored and specific reporting and monitoring are recorded.
Selected Accomplishments:
 Adjust and release claims using Facets and DMS software.
 Adjust claims as required by error / contract.
 Adjust claims related to refund checks and post refunds into the financial system.
 Responsible for collection activity and recovery functions of funds erroneously paid.
 Assist with new product training and policy development.
 Testing of new / improved systems for each client.
 Assist the Claims Manager and Team Leads with examiner / adjuster inquiries.
 Achieve / maintain or exceed established quality levels.
 Achieve / maintain or exceed established production levels.
 Trained in Government Regulations and HIPAA/HITECH Compliance.
 Accomplish monthly reporting of adjustment errors.
 Accomplish reporting of adjustment trends and training issues.
 Assist with client auditing.
 Apply selected benefits to respective contracts.
 Investigate / process coordination of benefits for Medicare, Medicaid and Commercial Carriers.
 Determine / identify erroneous processed claims.
Underwriter 1998 - 1999
Managed Care organization member, supplying health insurance community underwriting services
for small groups and self-employed individuals.
Selected accomplishments:
 Underwriting for State Reform small group contracts.
 Application of Maryland Insurance law and regulations.
 Resolution of broker and CareFirst sales representative inquiries.
 Interpretation of SEGO manual guidelines.
 Achieve / maintain or surpass established quality and production standards.
 Creation and maintenance of Excel spreadsheets as applicable to Underwriting.

2. Senior Claims Analyst 1996 - 1998
Adjudicate claims as relating to Preferred I and Preferred II, State Reform, and Georgetown
contracts. Assistant to the Adjustment Coordinator.
Selected Accomplishments:
 Achieve / maintain or exceed established quality levels.
 Achieve / maintain or exceed established production levels.
 Apply selected benefits to respective contracts.
 Investigate / process coordination of benefits for Medicare and commercial carriers.
 Examine / release MACESS claims.
 Determine / identify erroneous processed claims.
 Adjust claims as required by error / contract.
Claims Analyst 1995 – 1996
Adjudicate claims as relating to Preferred I and Preferred II and State Reform contracts.
Selected Accomplishments:
 Achieve / maintain or exceed established quality levels.
 Achieve / maintain or exceed established production levels.
 Apply selected benefits to respective contracts.
CAREFIRST BLUE CROSS BLUE SHIELD OF MARYLAND, Baltimore, MD (1991 - 1995)
Individual Account Manager 1993 - 1995
Examined, interpreted, researched medical policy coverage and illness diagnosis to resolve claims.
Provided customer service assistance to policyholders and medical providers.
Selected Accomplishments:
 Reviewed claims for pre-existing conditions and/or fraudulent circumstances.
 Resolved telephone customer service inquires.
 Audited and recouped overpayment of funds.
 Initiated and adjudicated timely claims payments.
 Provided additional aid to co-worker’s customer concerns/inquiries.
Claims Examiner / Team Scheduler 1991 - 1993
Examined, interpreted, researched medical policy coverage and illness diagnosis to resolve claims.
Selected Accomplishments:
 Reviewed claims for pre-existing conditions and/or fraudulent circumstances.
 Audited and recouped overpayment of funds.
 Adjusted claims as required by error / contract.
 Team planner / scheduler.
 Participated in the promotion and evaluation of team concepts.
 Inventory control specialist.
EDUCATION: Bachelor of Arts, Economics
Bachelor of Arts, Sociology
University of Maryland Baltimore County, Catonsville, Maryland