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Customer Service Representative

Location:
New York, NY
Posted:
August 20, 2014

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Resume:

Nancy Figueroa

** ** ***** **. *** *A

New York NY 10027

347-***-****

acfh64@r.postjobfree.com

Objective: To secure a Position that offers new Challenges and opportunities

Experience: Claims\approver New York Bronx NY 10461

Customer service claims rep 12/01/2013

• Inputs claims into systems, maintains pending files, matches professional claims to the

appropriate file and distributes new mail

• Reviews, processes and pays claims

• Handles incoming calls from policyholders, insurers and other external or internal customers

promptly and professionally

• Proven strong analytical skills, including demonstrated experience identifying and quantifying

problems and providing effective resolutions when dealing with multiple issues

• Determines proper payees for payment to assure that the Company is fully discharged from

liabilities associated with claims alternatives.

Experience: Medical Management \ Affinity Health Plan New York Bronx NY 10461

Customer service Representative 10/01/2012- 11/01/2013

Take incoming calls while checking eligibility and answering questions and inquiries about certain

procedure codes.

• Setting up authorization for procedure that are needed while verifying, providers eligibility

facility information to assure that patients received treatment that is needed.

• Contribute to team effort by accomplishing related results as needed.

• Approve certain procedure as departmental policy; while requesting clinical, attaching to

events already on file.

• Providing status on authorization while regulating that company stays within compliance

time frame by following up with pre-nurses and assuring provider’s and members that request

are being review.

Affinity Health Plan New York Bronx NY 10461

Customer service Representative 03/01/2010- 10/01/2012

Take incoming calls answer member inquiries about plan benefits and in network providers.

• Update demographic information on members account including Pcp changes and assisting

caller with any ongoing issue that needs to be address and monitor for resolution.

• Check on claims, premiums provide information and transfer to appropriate departments

through - out the office.

• Send out forms and letters as requested by providers and clients while being sensitive to their

concerns and needs.

• Provided eligibility to clients and providers on members account.

Distinctive Personnel\Affinity Health Plan New York NY 10165

07/0109 -10/01/2010

Receptionist

• Answer multiple telephone lines at a very high pace environment for insurance company.

• Answer incoming calls and questions then transfer to proper extensions throughout the office.

• Handled customer inquiries and complaints in a professional manner.

Education:

State Certified as Insurance Broker for Accident & Health 07/12/2008

The City College Of New York 01/24/2007

High School Equivalency Diploma

Skills: Clear and concise written and oral communication skills.

Faxes,copy and computer literate Bi-lingual Eng\Spanish.

Reference upon request



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