Kimberly

Frappier

*** *******

Mill Blvd

Bluffton, SC

29910

Phone: 843-

***-****

abg9qs@r.postjobfree.com

OBJECTIVE:

An interesting position with a growing company

EXPERIENCE:

November 2010

To

February 2011

Aerotek/Anthem Blue Cross Blue Shield South Portland, ME

Customer Service Representative

Received inbound telephone calls or paper and electronic claims from members and providers.

Resolved issues for members, providers, group administrators and brokers.

Analyzes the situation and completes research to ensure no rework or follow-up issues.

Applied knowledge of policies and procedures, products, legislation and claims workflow.

Interacted with systems to ensure claims are paid or denied based on terms of contract. Initiated

interaction with other areas to ensure claims are handled properly and thoroughly.

Interpreted claims to determine primary or secondary liability and recognize when additional information

is needed.

Make decisions on claims payment while considering benefit status, provider status, and impact on

Wellpoint, the provider and the member.

February 2008

To

March 2010

Care Core National Bluffton, SC

Customer Service Rep

Answers telephone calls in the customer Service queue, meeting departmental standards for speed of

answer and call volume, in a professional and respectful manner

Responsible for watching the phone queue, to know when the volume of calls is high, to not go on

Aftercall, or Aux time, unless urgent necessity.

Educate callers of the Health plan requirements for pre-authorizations, reconsideration, and appeals

Work with sites, patients, and physicians offices to investigate and resolve any pre-

certifications issues

Monitor call volumes to ensure that calls are being answered in a timely manner, according

To Health Plan contracts.

Responsible for giving professional, courteous, and accurate information to all callers

Maintain a working knowledge of all process and procedure changes, cpt coding and updated

training materials and use these changes and processes accordingly.

In conjunction with the Training Department, and Team Leader, act as mentor to new CS staff as

needed.

Perform other clerical functions as needed and directed by Customer Service Supervisor

November 2004

To

May 2006

Simplex Grinnell Westbrook, ME

Administrative Assistant

Maintained National Accounts and produced reports for Corporate Headquarters

Responsible for billing all accounts

Prepared Payroll.

Reviewed and answered correspondence in a timely manner.

Was instrumental in helping technicians learn new computer process.

Successfully handled dispatching technicians.

Answered telephones and responded within a timely manner.

May 2006

To

May 2007

Prime Care Family Practice Saco, ME

Patient Service Representative

ICD-9 Billing

Prepared for the next day by running the appointment schedules and ensuring chart's were pulled and

prepared for the Physicians.

Informed patients of necessary preparation for any tests they were having.

Scheduled appointments with specialist's for patients.

Helped patients with the referral process.

Answered phones and took detailed messages for the Doctors and the Nurses

Contact this candidate