Customer Service Manager
Resume:
SHEILA Wilken aco9k7@r.postjobfree.com
Qualification
Time Management Skills RIMS,Quick Link System Claims Analyzing
CAMS, UNET Empathic Listener Effective Communications Skills
Cisco Phone System Team Building ICD,CPT, HCPCS Coding
Professional Experience
Healthsmart Benefits, San Antonio, TX March 2012 to Present
Customer Experience Advocate
Provided customer service for an average of 55 80 calls per day. Assisted members and health
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care professionals with eligibility, medical/dental and vision benefits also claim adjudication.
Investigates, analyzes, and resolves outstanding issues to achieve customer satisfaction and takes
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responsibility for following through and bringing issues to closure
Reviewed claims, explanation of benefits and sent incorrectly paid claims for adjustments per the
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contract of the provider. Worked correspondents by updating, Rx, preexisting details also prepping pre
determination for review for group benefits eligibility determination.
Mega Life and Health, Fort Worth, Texas Nov 2007 to February 2012
Customer Care Professional
Provided customer service for an average of 50 80 calls per day. Or exceeding assisted members and
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health care professionals with claims, eligibility, medical/pharmacy, vision and dental benefits.
Assisted coworkers and team mates with complex/escalated issues to prevent manager involvement.
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Provided necessary research and call backs to keep open calls to a minimum.
Implemented new processes and systems for improving customer service satisfaction.
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Research, analyze, and resolve claims and call issues on claims processing, benefit design, pricing, eligibility,
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and any additional inquiries in a timely manner.
Reviewed provider contract agreement/fee schedules for adjustments related to balance billing inquiries.
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United Healthcare, San Antonio, TX May 2005 to Sept. 2007
Customer Care Professional
Provided customer service for an average of 80 90 calls per day. Or exceeding assisted members and
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health care professionals with eligibility, vision and dental benefits.
Assisted coworkers and team mates with complex/escalated issues to prevent manager involvement.
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Provided necessary research and call backs to keep open calls to a minimum.
Implemented new processes and systems for improving customer service satisfaction.
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Education
University of Phoenix, San Antonio, TX Aug 2011 Expected graduation: May 2014
Bachelor of Science, Major in Health Administration, with concentration in health management
Professional and personal references furnished upon request.
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