Customer Service Management
Resume:
DEREK JONES
**** ******* ***. ** *** #*** . Washington, D.C. 20011
Phone: 202-***-**** . E-mail: *****.*********@*****.***
SUMMARY OF QUALIFICATIONS________________________________________
- Strategic thinker with the ability to quickly learn and adapt in a new
working environment
- Ability to multitask and meet deadlines.
- Ability to work in a fast paced environment.
- Great interpersonal, oral, and written communication skills.
- Experience working independently and as part of diverse teams to
successfully complete tasks.
- Strong organizational and time management skills.
- Over 5 years of exceptional customer service experience.
- Proficient in Microsoft Office 2007: Microsoft Word, Excel, Access,
PowerPoint.
PROFESSIONAL EXPERIENCE_____________________________________________
CareFirst Blue Cross Blue Shield, Washington, D.C.
June 2010 - Present
Customer Service Rep II
- Clearly interpreted contractual language to clients and customers to
present benefit utilization and limitations.
- Determined and recommended the need for managed care initiatives for
more than 5000 customers.
- Corresponded with various clients within the business segment through
telephonic inquiries, written and /or electronic inquiries and claims
adjustments.
- Analyzed information required to effectively offer customer service as
it relates to the following inquiries but not limited to, pre-existing
conditions, knowledge of policies and riders, coordination of
benefits, and enrollment and billing transactions.
- Clearly interpreted contractual language to clients and customers to
present benefit utilization and limitations.
- Determined and recommended the need for managed care initiatives for
more than 5000 customers.
- Corresponded with various clients within the business segment through
telephonic inquiries, written and /or electronic inquiries and claims
adjustments.
- Analyzed information required to effectively offer customer service as
it relates to the following inquiries but not limited to, pre-existing
conditions, knowledge of policies and riders, coordination of
benefits, and enrollment and billing transactions.
Medix Staffing/ CVS Caremark, Monroeville, PA
June 2009 -June 2010
Program Representative
- Thoroughly understood the prescription and drug product in addition to
contractual provisions of the organization to provide efficient
communication and education to customers.
- Strengthened the performance of 20 level 1 associates, by providing
superb supervision, and offering extensive training and support.
- Successfully demonstrated the ability to carry out tasks in other
areas of expertise such as, claims adjudication, complex claims
adjustments, and processing of emails and written correspondence.
EDMC Online Higher Education, Pittsburgh, PA April
2009 - June2009
Assistant Director of Admissions
- Successfully enrolled students into online degree programs and ensured
they are successfully transitioned into the classroom.
- Assist potential students in determining their fit and eligibility
into the schools programs.
Guide potential students through the enrollment process which includes:
application, securing transcripts, financial aid, and academic acceptance.
- Advise students via telephone and email of their eligibility
requirements and progress towards enrollment.
High Mark Blue Shield, Pittsburgh, PA
September 2008 - April 2009
Member Services Representative
- Verified and explained to members specifics regarding their healthcare
and prescription benefits.
- Researched and applied the regulations of Medicare, Medicaid, COBRA,
and coordination of benefits toward effectively serving the customer's
need.
- Examined adjudicated claims to identify key elements and processing
requirements based on the diagnosis, procedure, provider, medical
policy, contracts, and medical policy procedures.
- Calculated and verified deductibles, maximums, co-payments and
coinsurance to resolve inquiries, facilitate adjustments, and
overpayments and underpayments.
OSI Outsourcing, Pittsburgh, PA February 2006
- September 2008
Account Representative
- Communicate with patients/clients/customers by telephone and/or
written correspondence to attempt to bring resolution to unpaid
accounts.
- Supply thorough customer service, maintain positive
patient/client/customer relations, and work efficiently in the name of
the client.
- Provide thorough, efficient, and accurate updates on computer files
for each call made.
- When requested, process all correspondences with adherence with
pertinent legislation guidelines where applicable.
- Knowledge, understanding, and compliance with all applicable Federal,
State, and Local laws and regulations that regulate the collection
industry.
- Knowledge, understanding, and compliance with NCO policies and
procedures.
- Maintain knowledge of functional area and company policies and
procedures.
- Provide feedback to management concerning possible problems or areas
of improvement.
- Make recommendations to implement improved processes.
- Perform other duties as assigned by management.
EDUCATION______________________________________________________________
Bachelor of Science, Communication . Clarion University, Clarion, PA .
December 2004
REFERENCES_____________________________________________________________
Rogers Laugand III 814-***-****
Jabari Weatherspoon 412-***-****
Jennifer Arbuckle 814-***-****
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