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Member Services Resume

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SUMMARY:

  • An interesting position with a company where my skills and professionalism would be exceptional for my employer's goals.
  • Bilingual, fluent in both English and Spanish.
  • Experienced in computer programs such as: NextGen, EDM, MS Excel, MS Word, MS Outlook, MS, PowerPoint and Internet Explorer, Qnxt, CRM, Financial Edge (FE), CAQH, M.O.R.R.I.S.E.Y (M.S.O.W)
  • Strong ability to organizing complex projects, defining project priorities, and delegating tasks.
  • Skilled at encouraging others and developing reports. Self - starting, goal-oriented strategist whose confidence, perseverance and vision promote success.
  • Proven ability to multitask

PROFESSIONAL EXPERIENCE:

Confidential

Member Services

  • Answering incoming Medicaid calls
  • Assisted members with pcp change
  • Assisted members and providers with eligibility verifications
  • Assisted members with account changes
  • Assisted members with provider searches

Confidential

Credential Specialist

  • Assist with the credentialing process.
  • Assist with organizing the paper work.
  • Assist with requesting required documents to the provider.
  • Assist with reviewing the paperwork and when done, forward to supervisor.
  • Assist with Scanning documents received by mail to myself.
  • Assist with Saving documents into appropriate file.
  • Assist with projects given.

Confidential

Financial Assistant

  • Assisted with entering data into the FE/ Financial Edge system.
  • Assisted with filing confidential documents.
  • Assisted with HR in organizing and filing documents.
  • Assisted with distributing the paychecks to the employees
  • Assisted with making copies of documents when needed.
  • Assisted with putting the customers receipts with the correct documents.

Confidential

Customer Service Rep

  • Assisted Marketplace members
  • Assisted Medicaid members
  • Helping the member look up doctors and specialists to see.
  • Review member’s claims.
  • Data entry or data correction when needed in the members account.
  • Assisted physician practices with eligibility questions.
  • Assisted with incoming calls regarding member benefit plans.
  • Helped schedule transportation for the Medicaid members.

Confidential

BHMG Revenue Management

  • Assisted with the refunds process.
  • Verified member’s information in Nextgen and EDM.
  • Identified and set to bill secondary insurances in Nextgen.
  • Assisted with Bad Address project, identifying members incorrect address and updating it in the system.

Confidential

Customer Service Rep

  • Assisted with incoming calls regarding member benefit plans.
  • Help the member pay the monthly premium.
  • Assist member registering for the Obama Care plan.
  • Helping the customer look up doctors and specialists to see.
  • Review member’s claims.
  • Data entry or data correction when needed in the members account.
  • Assisted physician practices with eligibility questions.

Confidential

Customer Service Representative

  • Answered questions and provided information to the customers about the insurance plan in question.
  • Assisted members with co-payment questions.
  • Able to explain members detailed coverage information.
  • Assisted Members with physician look up in order for the member to locate a PCP.
  • Also learned the system and had to use two screens to accomplish the tasks.

Confidential

Cashier/Customer service

  • Aided customers in locating merchandise.
  • Answered questions regarding currents sales opportunities for the customer.
  • Obtained merchandise from stockroom when merchandise was not on floor.
  • Able to handle money in cash register and balance at the end of the shift

Confidential

General Office

  • Received callers at establishment, determined nature of business and directed callers to destination.
  • Performed variety of clerical duties and other duties pertinent to establishment.
  • Compared data entered with source documents, and re-entered data in verification format on screen to detect errors.
  • Kept records of work completed.

Care giver

Confidential, FL

  • Assisted my grandmother with her day to day errands including: Dr. Appointments, groceries.

Florida Memorial University

Office Clerk

  • Directed and coordinated college registration activities.
  • Directed preparation of student transcripts.
  • Interpreted registration policies to faculty and students.
  • Coordinated class schedules with room assignments for optimum use of buildings and equipment.

Confidential

Office Clerk

  • Enter customer’s information in system
  • Opened, sorted and distributed incoming mail.
  • Collected and distributed paperwork, such as records and timecards, from one department to another.
  • Marked, tabulated and filed articles and records.
  • Scanned, Copied, Prepared documents.

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