1. CLAIREMARIE CONNORS
2955 Banner Road, Willow Grove, PENNSYLVANIA 19090
Ph: (267) 474-2909
cece901@hotmail.com
Summary
Dedicated professional with over 20 years in the customer services/health
insurance industry seeks a new opportunity which will utilize my values of leadership, creativity and
initiative as well as a proven ability to troubleshoot and provide solutions all while delivering with a
passion for exceptional customer service.
Skills
MS Word, Excel, Outlook, and various
other document and contract management
tracking systems.
Experience
Abington Jefferson Health System
Central Scheduling-Scheduler
August 2015-Present
Willow Grove, PA
Schedules and registers patient appointments for testing in accordance with established clinical
and financial requirements.
Assures patient safety by performing accurate patient database searches using double identifiers
in patient selection, selecting the correct physician and test selection upon scheduling and pre-
registration.
Verifies all patient demographic information for assurance of address, phone numbers and
additional system fields such as insurance information/policy numbers.
Verifies patient insurance for eligibility and coverage requirements such as needed pre-
authorizations, referrals and document/collection of copayments.
Aetna, Inc.
Contract Negotiator
Sept 1993-October 2014
Blue Bell, PA
Responsible for providers located in Bucks, Montgomery and Philadelphia
counties.
Responsible for several large healthcare providers, such as Abington Memorial Hospital, Temple
Health Systems and Mercy Health Systems/St Mary Medical Center.
Advise management on matters related to the administration of contracts or
employee discipline or grievance procedures.
Assess the impact of union proposals on company or government operations.
Call or meet with providers, or other interested parties to discuss contract
negotiations or grievances.
Investigate and evaluate provider complaints or arguments to determine

2. viability.
Recommend collective bargaining strategies, goals, or objectives.
Oversee activities directly related to making products or providing services.
Confer with customers by telephone or in person to provide information about
products or services, cancel accounts, or obtain details of complaints.
Keep records of customer interactions or transactions, recording details of
inquiries, complaints, or comments, as well as actions taken.
Check to ensure that appropriate changes were made to resolve customers'
problems.
Contact customers to respond to inquiries or to notify them of claim
investigation results or any planned adjustments.
Refer unresolved customer grievances to designated departments for further
investigation.
Identify alternatives to proposals of companies, or government agencies.
Interpret contractual agreements for employers and employees engaged in
collective bargaining.
Recommend collective bargaining strategies, goals, or objectives.
Write letters related to providers, such as letters to amend collective
bargaining agreements, letters of dispute or conciliation, or letters to seek
clarification of contract terms.
Negotiate collective bargaining agreements.
Prepare reports or presentations to communicate provider
dissatisfaction/satisfaction or related data to management.
Present the position of the company during arbitration or other negotiations.
Schedule or coordinate the details of grievance hearings or other meetings.
Examine budget estimates for completeness, accuracy, and conformance with
procedures and regulations.
Summarize budgets and submit recommendations for the approval or
disapproval of funds requests.
Consult with managers to ensure that budget adjustments are made in
accordance with company standards.
US Healthcare/Aetna, Inc.
Customer Service Representative
Sep 1993-Sep 1997
Blue Bell, PA
Develop strong relationships with network providers and internal business
partners leading to the achievement of provider satisfaction and efficiency
targets.
Manage resolution of problems and issues pertaining to contract
administration, delivery of medical services, claims payment and utilization
review on behalf of physician, ancillary and/or hospitals.
Accountable for all aspects of provider network development and
management.
Dedicated liaison between Provider and the company to educate about new
policies and efforts to troubleshoot and clarify related issues.
Increase provide satisfaction utilizing cross-functional work groups to
resolve issues; build strong relationships with providers and key contacts to
support on-going network management and negotiating efforts.
Provide network development, maintenance and servicing activities and

3. strategies in support of cross-market network management units.
Partner across the organization in support of network contracting activities to ensure
all aspects of operational implementation are completed on a timely and
accurate basis.
Initiate legal reviews as needed; ensure all required reviews completed by
appropriate functional areas.
Oversee activities directly related to making products or providing services.
Manage staff, preparing work schedules and assigning specific duties for
Saturday call center coverage.
Check to ensure that appropriate changes were made to resolve customers'
problems.
Confer with customers by telephone to provide information about products or
services, or obtain details of complaints.
Check to ensure that appropriate changes were made to resolve customers'
problems.
Contact customers to respond to inquiries or to notify them of claim
investigation results or any planned adjustments.
Refer unresolved customer grievances to designated departments for further
investigation.
Obtain and examine all relevant information to assess validity of complaints
and to determine possible causes.
Alfred Angelo Bridal
Service Representative
Jan 1990-Jan 1993
Willow Grove, PA
Certifications
Network Management and Conflict Resolution University of Notre Dame Mendoza
College of Business
Alliance
Education
Community Service
Currently a Community Based Volunteer with Big Brothers/Big Sisters of SE PA.
Volunteer, Habitat for Humanity
Volunteer, Philabundance, assistance in coordinating group volunteers from Aetna.
References
References available upon request