Customer Service Insurance
Resume:
Robert W. Jones, Jr.
Pittsburgh, PA 15235
Phone: 412-***-****
E-mail: *************@*****.***
Career Objective: A challenging opportunity as a Benefits Specialist
which would utilize my extensive experience to assist the
organization and the client to achieve its goals and
objectives.
Career Profile: High energy, detail oriented, cross-functional background
as a successful insurance specialist with an outstanding
record of success in all areas of the medical healthcare
field.
Background: - Workers compensation health claims.
- Contract and benefit analysis.
- Short term disability/Long term disability.
- Claims investigation with meticulous documentation.
- Skilled customer service/Cost containment.
- Reinsurance.
Technical Expertise: Microsoft Office Products
Employment Summary:
April 2010 - March 2011 Stivers Staffing Services Insurance
Verification Specialist
Verify patient/client medical insurance and any
related services. Document all insurance coverage
of services to be provided. Utilized all available
resources for ordered services in a timely manner
including referral sources. Notify members of their
financial responsibility of services to be
provided. Refer indigent patients to alternate
resources for assistance. Manage inbound calls from
patients, physicians and any other practitioners
regarding services provided.
May 2009 - February 2010 Medix Staffing Services Insurance
Investigation Specialist
Supporting drug manufacturers and biotechnology
companies by providing a variety of services for
their specialty products. Research pharmacy
insurance coverage, work with financial patient
assistance programs, obtain prior authorizations
and manage referrals sent to other specialty
providers.
August 2007 - May 2008 Insurance Overload Systems Medical Referral
Specialist
Data entry of medical referral authorizations into
a medical database for claimant's covered under
CIGNA Insurance Company.
January 2007 - August 2007 Venturi Staffing Partners Customer
Assistance Program Associate
Provide special payment plans for low-income
eligible residential customers in regard to the gas
utility services. Calculate monthly CAP credits and
arrearage forgiveness credits thru an on-line
database.
June 2003 - April 2006 Insurance Overload Systems
Case Management Support - Contact physicians and
hospitals to secure medical records for claim
payment determination.
Medical Billing Repricing Specialist - Processed
workers compensation health claims and calculated
fee schedule rates for adjustments.
Customer Service - Answer queries regarding status
of healthcare claims.
August 2002 - May 2003 Glover Staffing Services
Insurance verification specializing in coverage profiles.
Provide special payment plans for low-income
eligible residential customers in regard to the gas
utility services. Calculate monthly CAP credits and
arrearage forgiveness credits thru an on-line
database.
August 1998 - August 2002 Highmark Services Company
Customer Care Representative - Provide benefit
coverage to claimants, doctors and hospitals via
letters and telephone inquiries.
December 1991 - July 1998 Various employers and agencies including:
Insurance Overload Systems, Advantage Health,
Manpower Temporary Service, Employment Benefit
Claims and Allegheny Personnel.
Robert W. Jones, Jr.
77 Duff Road
Pittsburgh, PA 15235
Phone: 412-***-****
E-mail: *************@*****.***
August 1988 - November 1991 Metropolitan Life Insurance Company
Sales Representative, Customer Service, Claims
Processor, Systems Test Analyst.
June 1974 - January 1988 John Hancock Life Insurance Company
Benefits Specialist/Customer Service - Assisted in
the enrollment and installation of healthcare
benefits for client employees. Disseminated benefit
coverage information to employees and vendors.
Ensured client, employee and provider customer
service satisfaction.
Education: School of Computer Technology
In-house management courses
HIPAA 2009 Corporate Training Course
References: Excellent professional references upon request
Contact this candidate