Terri Santana has over 18 years of experience working for BCBSNC in claims processing and provider setup. She has extensive experience processing all types of commercial, Medicare, and Medicare supplement claims. She is skilled at COB processing and has taken on roles with increasing responsibility, such as mentor, trainer, and analyst. She is self-motivated, adapts well to changes, and excels at complex tasks.

1. Resume/CV name Terri Santana-resume
Objective
To work in a company that has the potential to grow, and excel as much as I do. I enjoy being
given tasks, and being able to prove my worth to my employers.
Summary
I have 18 years experience with BCBSNC (formerly PNHP), which includes working with
Commercial, Medicare, and Medicare Supplement. My experience includes COB for all three
lines of business. I amself-driven, self motivated, and a self-starting individual who works well
alone and in a team environment. I feel that I am proficient in many tasks that involve long
hours in front of a computer terminal and extended periods of unsupervised work. Working in
both the Claims and Provider shops has given me the opportunity to develop strong verbal and
written communication skills. Working in a fast paces production environment is something to
which I am accustomed. I easily adapt to workflow and management changes. I excel when
given time consuming tasks. Management in both Claims and Provider Set Up have felt
comfortable giving me difficult tasks to research and resolve.
Work History
Partners National Health Plans - Blue Cross Blue Shield, North Carolina 09/96 - current
I began working at PNHP in September 1996, through a temporary agency. I was hired on full
time January 20, 1997. When I first started I was keying claims, and worked my way onto the
Hospital Team. We processed all facility claimtypes, answered team ISF's and customer service
CSF's relating to claimissues. I learned a great deal during this time, built my knowledge of the
insurance industry, and excelled in quality AND quantity claims processing. When Customer
Service needed assistance I helped out on the phones with provider calls as well.
When BCBSNC brought PNHP, I was transitioned from PNHP work to the first training class for
ASO BCBSNC claims processing at Madison Park. During the day at work I learned a completely
new system, benefits, and company policies. During the evenings and on weekends I still
worked PNHP claims and corrected claims for almost a year via a laptop....until I fully
transitioned to ASO commercial claims processing. I processed all claimtypes, and due to my
increasing knowledge base worked on the projects/refunds team reprocessing claims, working
reports, etc. I took over the J-80 process and created a policy for it. I reprocessed claims from
reports, and helped create policies for running and working those reports. I was chosen along
with one other processor to travel to Durham for 2 months daily to learn the Blue Card
processing, and be able to help implement that and train it here in Madison Park.
That is how I began working with the Medicare Supplement department. I enjoyed this so much
I transitioned from ASO to Medicare Supplement, and began processing claims. I worked all
claimtypes, learned credit memos and worked reports. I began to excel at COB processing, and
then when we were caught up began helping out on the Medicare Advantage side right about
the time that NPI’s became affective and the company had to get ready for the change.
I realized how much I had missed Medicare, Amysis, and this type of claims processing, and
moved to the Medicare Advantage team. It was slow going, but the systemcame back to me
more quickly than I realized it would. I have worked my way from processing claims, to

2. answering questions, to an operations specialist/mentor position. I greatly enjoy researching
and fixing problem claims and issues, dealing with providers and members when there is a
need. I have dealt closely with other departments and management on high priority issues. I
have helped create and re-write policies. I have trained contract labor employees, as well as
classes for new hires. I am proud of the fact that management can call on me any time to
review/resolve an issue – and have confidence in my knowledge and skills to be able to
accomplish what is needed. I’ve tested upgrades, tested policies, and reported back to
management my findings. December 4, 2013 I moved from the Claims department to PSU,
changing from a Mentor to a Provider Database Analyst. I have greatly enjoyed learning this
side of the business (setting up providers, updating providers, learning how to read a contract
correctly, etc). With my extensive claims knowledge, it has helped me understand both sides
(Claims and PSU) and put them both in a different light. I am also able to help each department
understand the other a bit more…(because I can “speak the language of both” as they say) and
I’m grateful for that. I believe that we must all work together, as closely as we can, to ensure
quality for our members. In the end, QUALITY is the most important issue, no matter in what
department we work, our duties and/or titles, etc.
Office equipment used: Multiple claims processing systems for both the Commercial and
Medicare sides of claims, multiple line phones, fax machines, photocopier, ten key calculator
Salem Carriers, Winston-Salem, NC 08/94 - 09/96
I began my time at Salem Carriers at the Corporate office as a Repair Order Clerk. After three
months I moved to the Lansing Drive location into a Clerical/Assistant Dispatcher position. I
dealt one-on-one with drivers, answered multiple phone lines for dispatching calls, audited and
assisted with all of the drivers’ activity sheets, bills of lading, trip reports, fuel receipts, receipts
for out-of-pocket expenses drivers incurred on each trip, and payroll receipts while also
assisting with customer service. At times, when our receptionist was out, I often had to cover
her duties along with my own. After a year and a half, I moved to the Park Plaza location into
the position of Billing Clerk. I was still responsible for auditing and assisting with the drivers’
paperwork, and had other duties including: billing Alliance Display, Sealand Services (Polo
moves only), Polo/Ralph Lauren, Maresk, and American President Lines; breaking down and
delivering drivers paperwork to the appropriate departments, keeping track of missing and late
paperwork and/or trip numbers…all with corresponding reports having to be done and given to
my supervisor each week.
Office equipment used: multiple line phone, fax machines, photocopier, ten key calculator,
terminal computers (the Bluebird system, and Tom McCloud Software), utilizing IMB based
format systems.
Popi Temporary Services, Winston-Salem, NC 12/93 – 03/94
While still searching for employment on my own, I enlisted the aid of this temporary agency
and was placed at US Air in the position of Data Entry Clerk for a period of three months. My
primary duties included entering raw data from many types of batch filed into the US Air
computer system. Batches included: USBPA, Mouse, Mouse Rejects, Rejects, and others.
Office equipment used: computer terminal system designed especially for US Air, ten key

3. calculator, and reverse ten-key keypad, fax machines, photocopiers.
Popi Temporary Services, Winston-Salem, NC 04/94 – 07/94
I was also placed with Eduserve, Inc – a company that deals with student loans from all over the
United States. I collated background data from information given by Universities, as well as
from the students themselves. This was to aid and help the student load department in the
evaluation of each loan. I then entered the information into the Eduserve computer system.
Office equipment used: computer terminal system designed especially for Eduserve, ten key
calculator, and reverse ten-key keypad, fax machines, photocopier.
Beachland Cleaning, Vero Beach, FL 12/92 – 04/93
I was employed by Beachland Cleaning Services as a Secretary/Bookkeeper. My main duties
were answering multiple phone lines, taking and making appointments, billing all clients either
bi-weekly or monthly, doing manual bookkeeping, stocking and ordering all needed cleaning
supplies, and typing proposals dictated to me by my supervisor for bids on new projects. On
occasion, when a cleaning person did not show up for whatever reason, I was not afraid to go
to the site and help out with the work so that the appointments could be kept.
Office equipment used: multiple line phone system, fax machine, photo copier, IBM based
format system, Dictaphone, ten key calculater.
Dr. Fred J. Petrilla Jr., M.D., Ph.D., Vero Beach, FL 08/91 – 10/92
I was the Office Manager/Receptionist for Dr. Petrilla, in the field of Clinical Psychology. I
received patients, transcribed the Doctor’s notes and set appointments with his other
colleagues, answered multiple phone lines, filled out and billed insurance forms, billed patients,
sent medical transcriptions to other medical facilities, and acted as a part-time bookkeeper. I
also helped the Doctor in giving certain tests to patients unable to read and write for
themselves, grated certain tests, and typed many lengthy psychological evaluations.
Office equipment utilized: multiple line phone system, fax machine, photo copier, IBM based
format systems, Dictaphone, ten key calculator.
Education
Graduate of Everglades City High School, Everglades City, FL
Graduated 1991
Main course of study: Basic Accounting, Accounting I and II, Note Taking Skills, Excellerated
Typing