Customer Service Project Manager
Resume:
Shelly Ann Lopez
Goodlettsville, TN 37072
615-***-**** (H) 615-***-**** (Cell/ message)
********@*****.***
Objective: I am seeking employment with a solid, established company that needs a reliable,
motivated, dedicated employee.
Special Skills: Typing 12,000 ksph, Ten-key by touch, Windows XP and 7, Excel, Word, Access,
PowerPoint, Quickbooks, Internet, ICD-9 and CPT-10 medical coding. Have paid both physician and
facility claims for government and private entities. Had some COB t raining, but didn’t use it at
work. Can price J codes, audit claims and adjust errors.
Professional Experience
PHS/ Prison Health Services March 2010-May 2011
105 West Park Dr. #200 Brentwood, TN 37027 $36,000 annually
Claims Examiner Processed electronic and paper medical claims from physicians and facilities. The
patients are inmates in jails and prisons from around the United States. Each provider or facility has
contracts with fee schedules and special instructions that need to be read in order to make correct
payments. This is a very manual process no automatic processing is done. Met or exceeded
p rocessing guidelines until my system was upgraded from Windows XP to Windows 7, which made the
system I worked on to pay the claims very slow. This company is in a merger, due to be closed in early
J une. The Claims Department is being moved to another state.
Contact: Donna Snyder, HR 615-***-****
Coventry Healthcare Nov. 2008 March 2010
Cool Springs Blvd-Franklin, TN $30,000 annually
Service Operations Specialist Made phone calls to existing providers in the network, to verify the
location address and all other demographic information. If the phone number in the system was
i nvalid, used different databases and websites to attempt to locate the correct information for said
p rovider.
HCA Healthcare Mar. 2008 Nov. 2008
551 Metroplex Dr-Nashville, TN $29,000 annually
Government Collections Pull up accounts that have a balance due and attempt to resolve the issue. If
t he account is not paid, I call the insurance company to determine what is necessary. If the claim is
not going to be paid, determine where to send the account to be written off.
Contact Tina Robinson, Supervisor 615-***-****
HealthSprings Insurance J un. 2004 – Mar. 2008
44 Vantage Way-Nashville, TN 37228 $32,000 annually
Senior Claims Examiner-Input medical claims into system, and answer all edits to ensure proper
payments. I average 150% production level, with approximately 95% accuracy in procedure and 98% in
f inancial. I enter and adjudicate approximately 200-300 claims per day, and my goal is only 160 per
day. Actual start date Jan. 2004, but took off three months and went back to work.
Contact: HR 615-***-****
C IGNA Dec. 2001- Jan. 2004
2 Vantage Way-Nashville, TN 37228 $25,000 annually
Claims Analyst-Input Medicare claims into system, and answer all edits to ensure proper payments.
A nalyze injections, to insure proper payment. Check system for duplicate payments, and for correct
Medicare numbers. Received award in December 2002 for having the highest accuracy level for the past
6 months. Have consistently performed above standards, in both accuracy and volume processed.
Healthcare Data Solutions Dec. 2000 - Dec. 2001
1021 Woodcross Court - Franklin, TN 37067-2678 $26,500 annually
Claims Analyst-I evaluated claims that were paid by insurance companies to identify potential
refunds due to
duplications or contractural errors.
Contact: Deanna Allen-Project Manager 615-***-****
P rudential Insurance Co. of America April 1997-Nov. 2000
5800 Canoga Ave.-Woodland Hills, CA 91367 (6 months temp-to-hire) $33,600 annually
Team Lead-Senior Customer Service/Senior Claims Evaluator--Evaluated customer complaints, and
represented Prudential in the Appeals department conducting Arbitration Hearings supervised staff of
5 customer service representatives for 2 years. Performed the daily update meetings. Sat with
customer service personnel to advise on how to better assist the policyholders. Chosen to work on
special projects, such as using spreadsheets, writing letters, performing QR, and mentoring my co-
workers
Contact: Jeff Hendrickson-Manager 818-***-****
F irst Colony Life Insurance Co. Dec 1991-Apr. 1997
20750 Ventura Blvd #450-Woodland Hills, CA 91365 $11.00 hourly
Case Manager--Served as liaison between underwriting staff and general agencies performing
customer service/data entry and issued detailed life insurance policies. Received and reconciled
payments for initial premiums.
Contact: Donna Gonzalez 818-***-****
Care America Health Insurance Co. May 1989-Dec. 1991
Chatsworth, CA $ 9.75 hourly
Accounts Receivable/Commissions/Data Entry--Worked up sales commission reports. Changed broker
records and performed customer service. Received, reconciled and entered monthly premium payments
on a daily basis and called clients with overdue account balances
Contact: Pat Borgstrom 818-***-****
Charles E Thomas Co. J uly 1988-May 1989
Gardena, CA $ 9.00 hourly
Accounts Receivable/Data Ent ry--Read technicians' worksheets and constructed statements that were
concise and easy for the layman to understand. Entered these statements into an on-line system.
Contact: Josiah Brush or Brian Hurley (310-****-****
Special Designations: Fundamentals of Life & Health Insurance, LOMA/ Associate, Customer Service,
L OMA
Contact this candidate