TRACI BURNS

790 Durham Lane

Grayslake IL 60030
Home: (847) 548-8073
Cell: (847) 508-5181
e-mail: tb4burns@comcast.net

CAREER SUMMARY

Accomplished professional with broad-based industry experience in Health & Welfare including
ERISA self-funded and fully insured plans, Defined Contribution and Defined Pension Plans.
Diversified background includes six years as accomplished Subrogation Specialist, effective
negotiating skills, recovering top settlements for health insurance plans. Along eight years
medical claims processing, Control of Documents required by FDA, HIPAA, CMS, and the Joint
Commission.

PROFESSIONAL EXPERIENCE

LIFEWATCH INC. August 2008 – February 2010

Complaints and Approval Specialists

• Administration of marketing materials, work with Marketing Department to ensure

adherence to regulatory standards, proofreading of final drafts.

• Complaint Administration, assessed inbound complaints for priority upon receipt.

Responsible for ensuring the full documentation of all complaints, communicating with
the responsible managers, obtaining results of investigations performed, assessing the
adequacy of proposed resolutions, final communication back to customer/patient sales
representative, or executive board. Closing and filing of complaint records.

• Maintained revision control on all documentation passing through the Compliance

Department.

• Was part of the team responsible for ensuring The Joint Commission’s on-site audit was
successfully completed. This included the audit of all functional areas in the company.

HEWITT & ASSOCIATES November 2006 – August 2008

Auditor / Compliance Specialist November 2006 – August 2008

Audit client team transactions for Defined Pension, Health & Welfare, Defined Contributions,
and Multi Purpose Health Operations.

• Worked with clients to set expectations regarding timing and deliverables for their
audit results.
 • Analyzed requirements, plan documents and data received based on knowledge of
DB, DC, and HW Plans to ensure quality of data.

• Assisted in an audit of the Requirements Documents for client teams that are
either just going live or are in the process of making changes in the Plan
Documents.

• Consulted with client teams on broad array of legal and administrative guidelines

• Wrote appropriate recommendations, counseled clients regarding their audit

summaries, and made corrective measures to clients’ accounts based on results.

• Ensured accountability of clients’ records by cross-referencing Hewitt’s system to

guarantee accuracy of participants accounts.

TRUSTMARK INSURANCE, Lake Forest, Illinois 1991 - 2006

Recovery Specialist / Law Department (1999 –2006)

Completed comprehensive recovery reports for CEO, CFO, General Counsel & Recovery
Department that were utilized to track the units’ revenue goals for the year in both subrogation
and overpayment matters.

• Assisted Paralegal in the Compliance Department in her absence answering

Insurance Department complaints for both the fully insured business and ERISA
self-fund business.

• Assisted manager by taking over the drafting of the HIPAA Regulation

procedures for the Recovery Department, which ensured compliance with the new
regulations.

• Commended for efficiently handling specific work issues involving complex

information.

Claims Examiner (1991 – 1999)

• Acknowledged as mentor for fellow analysts and resource for both large case
management and the law department.

• Consistently met individually defined claims quality and production standards

• Chosen to be part of a model office environment and assisted a complete change

in the claims process software and procedures including the training of claims
processors in a new more comprehensive system.
 EDUCATION

LOMA & HIAA, Customer Service courses Medical Terminology.

TRUSTMARK training courses and other insurance related courses that became available.
Hewitt & Associates training courses in Health & Welfare Defined Contribution and Defined
Benefits.

PROFICIENCIES

• MS Excel
• MS Word
• TBA Software
• Time Management
• Communication
• Customer Relation / Building
• Phone/Computer Skills
• Administration & Organization