Customer Service Medical

DENISE A. COVERT Home: 313-***-****

**** ****** ****** ****: 313-***-****

Dearborn Heights, MI 48125 *******@*****.***

OBJECTIVE

Seeking an entry level position that will utilize my skills and abilities in areas of clerical support and

customer service as well as my strong organizational skills and computer knowledge. Highly motivated

team member with the ability to work effectively in team situations or independently. Efficient and able

to multi-task and prioritize in a fast-paced environment .

PROFESSIONAL EXPERIENCE

UniCare Life and Disability Insurance (subsidiary of WellPoint, Inc) Dearborn, Michigan 1991 – 2008

DISABILITY CARE COORDINATOR (2005-2008)

Adjudication of short term disability claims in a timely manner. Managed and processed claims in

accordance with statement of work requirements. Knowledge of CPT and ICD-9 codes and medical

terminology.

Confirmed eligibility requirements

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Gathered and documented clinical information to substantiate certification of disability benefits

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Maintained awareness of the ERISA fair claims practices model act, privacy regulations, and state-

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mandated laws and abided by them as necessitated by each individual claim

Corresponded via letter and telephone with employees, physicians, employers, hospitals,

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rehabilitation facilities and other vendors to obtain claim information

Provided customer relations support

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Performed general claims support duties as needed

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CUSTOMER SERVICE REPRESENTATIVE (2003-2005)

Provided customer relations support.

Handled customer inquiries regarding health insurance inquires and complaints in a professional

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manner

Addressed customer concerns, researched and resolved problems to ensure service satisfaction

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Accountable for claim adjustments

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SENIOR CLAIM APPROVER (1997-2003)

Processed medical claims including complex claims such as Medicare, Coordination of Benefits, Flexible

Spending Account and inpatient services; according to productivity and accuracy standards. Knowledge

of CPT and ICD-9 codes and medical terminology.

Processed hospital bills such as HCFA 1500 and UB82 claim forms

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Accountable for claim adjustments

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JUNIOR CLAIM APPROVER (1996-1997)

Processed basic medical claims such as office visits, x-rays, injections, outpatient services, chiropractic

visits and physical therapy; according to productivity and accuracy standards. Knowledge of CPT and

ICD-9 codes and medical terminology.

CLAIM INPUT PROCESSOR (1993-1996)

Performed data entry of medical and dental claims.

CLAIM SERVICE ASSISTANT (1991-1993)

Tracked and distributed incoming correspondence. Researched claims on microfiche. Assisted with filing

confidential patient information.

EDUCATION

Diploma, Crestwood High School

Dearborn Heights, Michigan

TRAINING

Security and Fraud

HIPAA (Health Insurance Portability and Accountability Act)

ERISA (Employee Retirement Income Security Act)

Customer Service

TECHNICAL SKILLS

Proficient use of Microsoft Word

Basic knowledge of Excel

Excellent interpersonal and communication skills

Knowledge of general office machines

General office skills

Multi-line phone skills

Typing 50 wpm

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