Call center representative
Resume:
High School Diploma:
South Grand Prairie High School
Grand Prairie, TX
ad40fj@r.postjobfree.com
Newark, TX 76071
Skills
• Complex Problem Solving
• Property Owner Representation
• Coverage Assessment
• Client Interviewing
• Critical Thinking
• Active Listening
Verbal and Written
Communication
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• Conflict Resolution
• Regulatory Compliance
• Team Collaboration
• Claim Form Analysis
• Complex Mathematics
• Claims Processing
• File and Record Management
• Research and Data Analysis
• Insurance Claim Regulations
• Report and Records Review
• Calm Under Pressure
• Fraudulent Claims Investigation
• Computer Skills
Education And Training
Energetic and enthusiastic insurance professional motivated to succeed in fast-paced and deadline-driven professional environment. Comprehensive knowledge of claims adjustments with special knowledge of auto appraisals and CCC pathways estimations.
Amazon - Packer
Haslet, TX
11/18/23 - 04/10/24
Picking, pulling orders
Quality checking orders
Packaging orders for delivery
Warehouse environment
CVS/OMNICARE - Claims Adjudicator
Grand Prairie, TX
10/2019 - 11/2022
Prime Therapeutics LLC - Pharmacy Technician
Irving, TX
10/2013 - 06/2019
Natasha Merrill
Summary
Experience
Negotiated and settled claims according to information presented through reports, research and data verification.
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Processed and produced billing claims, while generating significant company savings.
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Performed insurance claims research to verify data and investigate reported information.
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Processed claims paperwork efficiently with in-depth research and top-notch communication skills.
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• Worked closely with employees and managers at all levels.
• Entered claim transactions, payments, reserves and other documentation.
• Reviewed claims to ensure accuracy, resulting in multiple claim reductions. Completed required investigations on referred files within established timeframes.
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• Researched and followed up on denied insurance claims. Evaluated evidence with ultimate goal of creating positive outcomes for client's claims.
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• Investigated questionable claims to determine payment authorization. Leveraged database to confirm validity of prescriptions, patient data and drug side effects.
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Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.
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Maintained pharmacological practices by checking drug inventory, stocking medications and monitoring supplies.
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Flagged potential side effects and allergies to prescribed medications for patients.
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Teamed with peers, technicians and pharmacists to prioritize and complete orders.
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• Verified prescriptions and drug labels, documents and packages. Refilled medications, offered insight into over-the-counter products and verified insurance benefits.
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Received and verified daily incoming drug inventories, reported discrepancies and logged items into inventory system.
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Improved inventory management procedures to reduce overhead, backorders and overstock.
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Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
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Interpreted and processed medication orders under supervision of pharmacist.
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• Prepared prescription transfers to other pharmacies. Inspected medication storage locations to monitor drug expiration dates and supply adequate inventory.
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Transmitted claims to insurance companies for payment and reconciled EOBs.
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Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
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Greeted customers and answered questions regarding personal medications or over-the-counter pharmacy products.
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Monitored supply inventory and promptly submitted replenishment orders to prevent shortages.
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Checked medications for content, accuracy and completeness of drug packaging and labeling.
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• Established or maintained medications and other patient profiles. Cleaned and maintained equipment or work areas according to prescribed methods.
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• Mixed pharmaceutical preparations according to written prescriptions.
• Operated cash registers to accept payments from customers. Assisted customers by answering questions, locating items or referring to pharmacist for medication information.
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Ordered, labeled and counted stock of medications and entered inventory data into computer.
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Transferred medication from vials to sterile, disposable syringes using aseptic techniques.
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• Prepared and processed medical insurance claim forms and records. Received and stored incoming supplies and informed supervisors of stock needs and shortages.
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Received written prescription or refill requests, verifying information for completeness and accuracy.
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Received written prescriptions and refill requests from patients, evaluating information for completeness and accuracy before filling.
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Prepacked bulk medicines, filled bottles with prescribed medications and typed and affixed labels.
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Computed charges for medication or equipment dispensed to hospital patients and entered data into computer.
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Communicated effectively with doctors and insurance agencies to resolve prescription cost discrepancies.
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• Answered telephones to respond to questions or requests.
• Entered prescription information into computer databases.
• Maintained proper storage and security conditions for drugs.
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