Customer Solutions Representative Resume New Jersey NJ - Hire IT People

Objective:

To be a prolific contributor to the Company’s success in an Information Systems Position utilizing my educational background and professional skills

Education:

Confidential
Bachelor of Science Degree in Information Systems Summa cum Laude
Member of Confidential

Work Experience:

OptiCare Managed Vision June 2008- Current
OptiCare partners with Managed Care Organizations around the country to offer vision care services to over 3.5 million insured members while keeping costs low for clients

Claims Systems Analyst /Health Specialist May 2011- Current
Test and maintain claims payment systems, generate production reports, analyze data to discover non-preferred practice methods and opportunities to reduce costs

Test new claims payment software and cross functional databases on various scenarios in multiple settings and keep thorough documentation of test results
Troubleshoot and resolve claims processing errors
Develop, design, modify and maintain Crystal Reports across SQL-based applications
Offer creative solutions to increase the amount of claims that can be processed automatically, reducing the need for manual adjudication and increasing productivity
Develop and monitor trend reports to detect overpayments, over- utilization and possible billing abuseand research methods to most efficiently recoup overpayments–saving company $38,000 within two months
Present opportunities and recommendations for reducing costs
Maintain, update and implement system configurations in a SQL database as needed to fit business needs or scheduled maintenance

Customer Solutions Representative Jan 2009-May 2011
Provided high level comprehensive problem resolution, educated physicians and their staff on company policies and procedures,and served as a knowledge leader for external and internal customers

Exceeded benchmarks in performance reviews which were measured by the volume of problem resolution opportunities that were taken on and the timeliness in which these issues were resolved
As a result of receiving an “exceeds standard” rating in the Adaptability/Flexibility category of my annual performance review, I received special projects such as drafting letters and training team members on conducting proactive outreach calls to ensure everything was going well for our physician’s practices

Bilingual Customer Relations Representative June 2008-Jan 2009
Quoted eligibility and benefits to customers, explained benefits and claim statuses to members and physicians, assisted customers with locating physicians

Consistently exceeded benchmarks on customer service quality audits
Ranked number 1 out of 5 employees in my unit on my annual performance review due to my productivity scores

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Customer Solutions Representative Resume

New Jersey, NJ

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