Customer Service Representative

SUSAN A. HILDERBRAND

*** ******* ***** 610-***-****

Allentown, PA 18104 *****************@*****.***

SUMMARY OF QUALIFICATIONS

Knowledgeable, effective customer service representative with accomplished

expertise

in communications, customer relations, problem identification solutions and

data entry.

Highly trained and proficient working in a high volume call center with

error free work.

. PROFESSIONAL EXPERIENCE

AMERICOLD LOGISTICS 2004-2008

Fogelsville, PA

Customer Service Representative

. Responsible for phone order tracking for the Ortho-Johnson&Johnson

Company.

. Responded to customer inquiries, data entry, and processed shipping

for orders.

. Answered calls and questions to facilitate efficiency and timeliness.

. Problem solving and trouble shooting in sales area in order to

maintain a steady

and smooth working environment.

THE HARTFORD INSURANCE COMPANY

2000-2004

Fogelsville, PA

Customer Service Representative-Enrollment Processor

. Responsible for answering calls associated with provider and member

inquiries.

. Entered data online and edited corrections of applications. Contacted

members to verify information.

PENN TREATY NETWORK AMERICA INSURANCE COMPANY 1999-2000

Allentown, PA

Claims Examiner

. Reviewed claims and evaluated eligibility for benefits giving

qualifying criteria of policy.

. Facilitated care management process and case management process.

. Handled issues related to plan and delivery of care.

. Assessed appropriateness of level of care.

. Determined eligibility of provider and calculated benefits payable.

AETNA US HEALTHCARE

1998-1999

Allentown, PA

Claims Benefits Specialist

. Proofed entire claim submission to determine review or apply medical

necessity,

Coverage benefits,discrepancies, and cost containment procedures to

adjudicate the claim.

HIGHMARK BLUE SHIELD

1990-1998

Camp Hill, PA

Claims Examiner-Financial Correspondent

. Screened and evaluated Medicare claims to assure accuracy.

. Entered data online and edited corrections of claims for services

under Medicare Part B Program.

. Established eligibility of services on the basis of Medicare payment

policies.

. Used Knowledge of medical terminology, Medicare reference material,

and the claims processing system in order to evaluate and process

complex claims.

. Selected as a team member for a pilot project to determine the

benefits and costs of keying rendering positions.

. Performed claim adjustments and prepared written correspondence.

. Reviewed claims information to verify unsolicited refunds from

providers and beneficiaries.

CONTINUING EDUCATION

Customer Service Training, The Hartford Customer Service Group.

Claims Examining Courses focusing on medical terminology, coding, and

keying, Highmark Blue Shield and Aetna.

Penn State, Accounting Credits

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