Customer Service Administrative Assistant
Resume:
Kimberly
Frappier
Mill Blvd
Bluffton, SC
29910
Phone: 843-
**********@*****.***
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