Customer Service Management
Resume:
Michele E. Calvin
**** ******* **** ******, ** **630
Cell Phone: 409-***-****
E-mail - **********@*****.***
Summary of qualifications
Self-Motivated Senior
Benefit Claim Professional dedicated to the growth and development of
private and government organizations. A visionary with the ability to
serve as catalyst for profitable and orderly workforce change.
o Able to establish rapport and creditability with diverse groups
ranging from claims management to information technology personnel.
o In-depth experience in health care claims processing, training,
development of training curriculums, strategy project management
procedures and job aides, corporate claims auditing, and customer
service.
o 19 years experience in commercial and government claims
processing, claims training, design and methods development,
auditing, and customer service.
o Expertise in staffing and recruiting. Adept in work flow and
Quality Management
o Deep commitment to helping others
o Exceptional organizational abilities and inquisitive problem
solver Highly motivated self-starter and analytical thinker
Temporary WORK
EXPERIENCE
Medix staffing/ CVS Caremark, Irving, TX April 2010 - May 2010
Research Benefits Rep
o Received inbound and made outbound calls to resolve specialty
pharmacy orders.
o Researched benefits on major medical and pharmacy plans and
communicate to benefits and patient's responsibility to patient and
providers.
o Collect co-pay via on-line credit card system from patient or refer
patient to co-pay assistance program if patient unable to pay co-
pay.
Permanent WORK EXPERIENCE
Aetna, Dallas, TX 1-2000 - 2-2010
Operations Trainer (8-2006 - 2-2010)
o Trained, led, and coached personnel and staff on claims processing,
customer service, claim policies and procedures including
navigation on GEMS and QNXT systems. Results of training led to
significant reduction in claims backlog and increased customer
satisfaction.
o Provided technical expertise relative to policies, procedures, and
customer service applications to claims, provider relation, and
patient management staff. Served as subject matter expert
providing technical assistance when needed on claim system,
Medicaid policies, MS Office Suite and Windows Desktop support.
Claims Benefits & Senior Claims Benefits Specialist (9-2000 - 4-2001, 1-
2003-8-2006)
o Entered, reviewed and released payment of high dollar HMO Medicaid
claims via GEMS system. Consistently achieved and exceeded standard
quality rating to attain company-paid bonuses.
o Take inbound, make outbound calls to resolve issues from providers,
and ensured that claims were handled according to Medicaid
guidelines.
EDUCATION
Baylor University; 102 Hours; Majors -Biology and Sociology
SYSTEMS & OFFICE ADMINISTRATION
MS Office Suite: Word, Excel, Power Point,
Adobe Professional Suite, Outlook, and Windows XP
Claims and Benefits Systems: QNXT, MHS, GEMS,
Rumba, Health Practice Review, Encoder Pro, iHealth,
ABF-Emdeon, People Safe, People Soft, Citrix [CE2000]
Typing: 60-70 WPM; Exceptional Data Entry
keystrokes; 10-13K KPH
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