seeking a position which will allow me an opportunity to grow
and expand my skills in customer service.
Benefit Verification/ Senior Claims
December 2011 to Present
Accountable for Facets configuration solutions supporting Commercial and Community and State markets. Ensures departmental policies and procedures are followed. Works with other operational teams and business partners to resolve operational issues. Interacts with key Medicare and Medicaid business partners, including, but not limited to: Claims Operations, IT, Project Management, Health Plan Operations, Network Management. Serve as subject matter expert on pricing and configuration methodologies. Identify and resolve operational issues using defined processes and methodologies. Set priorities on daily activities. Participates in weekly team meeting. Identifies issues that might impact quality or quantity. May lead and coordinate configuration teams in cross functional projects and achieve timely and accurate deliverables. May participate in project management, analysis and sign-off of system enhancement projects
January 2011 to December 2011
Receiving inbound calls for service support regarding insurance benefits. Resolving claim issues related to patients having the proper benefits as well as seeing that providers are paid correctly. Insurance Verification working with both outbound & online applications such as I-Link Blue, BC/BS, Avality ect to confirm insurance information for Medicaid. Dispensing medication in a timely manner. Working with patient's through special government agency to provide copay assistance for customers & patients.
January 2010 to December 2010
Home Retention Loans
Analyzes customer's situation and collateral risk to present alternative solutions including Special forbearance Plans, Repayment Plans, Modifications, Assumptions, Pre-foreclosure / Short Sales, and Deed in Lieu, Maintain accurate company records. All inquiries must properly documented within the system of record. Update customer records as necessary and provide appropriate details as to the nature of the call. Determines and implements proper processes and procedures to solve customer problem and satisfy customer investor/insurer guidelines
2002 to 2004
2000 to 2002
Qualifications & discuss, print, file, fax, mail, order and document depending on the request type. Ensure proper customer follow up is made and maintain high quality and satisfaction service objectives.
Sept. 2009 - Jan. 2010
Insurance Verification working with both outbound & online applications such as I-Link Blue, BC/BS, Avality ect. To confirm insurance information for Medicaid
April 2007 - July 2009
Magellan Health Service
Customer Service Rep II
Receiving inbound calls for service support regarding metal health
patients, setting up inpatient & outpatient authorizations for mental
health & substance abuse. We also talk patients through crisis situations using empathy and other customer service tactics. Resolving claim issues related to patients having the proper benefits as well as seeing that providers are paid correctly working with remedy, power points, excel, ECT.
Jan.2005 - Jan. 2007
Conn's Corp. Office
Inbound/Outbound Collection Agent
Receive Inbound/outbound calls from customers regarding their delinquent account and payment plans working with remedy, power points, excel, ect.
Dec. 2002 - Jan. 2005
United Health Care, Plano, TX.
Call Center / Customer Service
Receive inbound calls from customers regarding their benefits, in network and out of network, setting up authorizations for patients to see medical/dental providers, mail order, and provider relations. Resolving Claim issues related to patients having the proper benefits as well as seeing that providers are paid correctly. Started as backup in Mailroom worked my way up to call center floor.
Aug. 1997 - Aug. 2000
United Parcel Service
Loading and unloading of packages
Repackaging of materials
Sorting packages according to Address