SUMMARY:

To find a job that utilizes my skills so I can bring maximum performance to my employer.

WORK EXPERIENCE:

Confidential, Irving, TX

BENEFITS SPECIALIST

Responsibilities:

• Assisting clients with issues pertaining to Confidential Commercial Insurance preventing or blocking client from obtaining prescriptions which in turn allows for assisting client with getting that insurance removed to allow the processing of that prescription allowing client to obtain prescribed medication.
• Assisting on the ACD line receiving calls from Commercial Insurance Carriers, Patients, and Servicing Providers regarding refunds, EOBs, Overpayments, Recoupments, Vendor Letters, Mismatches, Settlement Proposals, Reclamation Claims and Billing Issues.

Confidential, Little Rock, AR

BENEFITS RELATIONS SPECIALIST

Responsibilities:

• Possessing strong oral, written and customer service communicative skills as well as initiative, and multitasking and making sure customer and clients request which included research, review of policies, referrals, documentation and follow up always had resolutions in a timely manner.
• Developing and maintaining a working relationship with customers to meet contract deliverables per projects as well as communicating effectively with customers, providers, etc. and adhering to state and federal protocols pertaining to data confidentiality, security, HIPPA compliance and researching cases to verify in Curam if coverage information has been set up.
• Documenting and monitoring while using project - tracking database to build a comprehensive database of activity while also maintaining correct statistical data to meet specific set reporting requirements while arranging timely collection and data entry of all necessary documentation as well as communicating needs and requests with other teammates as needed.
• Meeting deadlines, prioritize, pay attention to details, maintain confidentiality, problem solve, interpret, read, apply laws, rules and regulations and making sure customer and clients request which included research, review of policies, referrals, documentation and follow up always have resolutions in a timely manner.
• Reviewing cases in Curam system to verify issues pertaining to the processing of applications and inform caller of any pending information to continue application process and review information received or not in the Docushare system pertaining to processing of application and also inform caller of letters sent to them.
• Providing opting out information to cancel HCIP coverages with Private Option Carriers in addition to redirecting calls to correct parties when given incorrect contact information and merging multiple accounts with several ID numbers under one account to be linked together to pull up all numbers under one account with one ID number.

Confidential, Little Rock, AR

CUSTOMER SERVICE REPRESENTATIVE

Responsibilities:

• Establishing and maintaining professional rapport with clients, providers, physicians and hospitals and working with Analysts and other departments to research problems in regards to processing of claims as well as maintaining and assuring accuracy of documentation.
• Handling customer service calls from members, providers and client representatives as well as analyzing problems during phone inquiry and applying appropriate resolutions and verifying dental, vision and health insurance benefits and eligibility for members and healthcare providers and ability to learn claim processing as well as adjustments and locating health care providers for members as well as continuous knowledge of numerous benefit interpretations.

Confidential, Sherwood, AR

CUSTOMER ORDER MANAGEMENT, REPRESENTATIVE

Responsibilities:

• Answering calls for various facilities to place orders for medical supplies and equipment in addition to preparing reports such as ZPSD, In and Out Orders, and Vendor Cancellations.
• Inputting faxes daily, process credits, debits, returns, provide Proof of Delivery requests and complete daily processing of workflow and responding daily to email request and research issues with shipping as well as resolve and track customer complaints and issues.
• Monitoring continuously Case Management ensuring timely resolutions for orders or issues unresolved on the first call and resolving issues pertaining to misdirected freight, shortages and overages on orders.

Confidential, Dallas, TX

REFERRAL SPECIALIST

Responsibilities:

• Assisting insured customers and medical facilities with the process of setting up referrals for insured customers to visit certain doctors, facilities, or specialists pertaining to particular medical concerns the customer may have and locating certain hospitals, facilities, specialist and doctors to set up referrals for visits.

Confidential, Dallas, TX

CLAIMS SERVICE REPRESENTATVIVE

Responsibilities:

• Assisting with customer service and assistant to callers pertaining to questions about claims and entering new claims in the Confidential of Loss system for auto accidents, dispatching claims to appraisers to inspect client’s vehicles once accident has occurred and creating invoices for payment of rentals for clients.
• Routing over 130 claims to the Property Damage adjusters to provide work through their work managers in addition to preparing subpoena request received from attorneys for information pertaining to cases in court.
• Providing clerical support to claims adjusting and management staff consisting of folding over 600 letters generated daily mailed to clients, lawyers, repair shops, also prepare copy work of files for litigation adjusters to assist them in court to include the entire file with color photos, notes, and any additional information pertaining to the claim.