Customer Service Insurance
Resume:
Apt A*** 312-***-****
tamikasuggs@msn.c
om
Westmont, IL
60559
Tamika Suggs
Objective: To secure a challenging position that will utilize
my skills and experience with an organizations
allowing professional growth.
Qualifications: Proven to have ability to provide efficient and
effective support in a fast paced, high volume
environment. Excellent communicator with people from
diverse backgrounds and/or professional levels.
Highly skilled self-motivated, creative, well
Education: organized and will maximize time and productivity I
can work independently and/or in a team environment.
Also, have experience working with Office/Windows
2000 / XP OS and Macintosh X (10.4) OS systems.
2010- Present CTU (Online)
Colorado Springs, CO
Health Insurance Specialist ( Medical Billing and
Coding)
1997 - 1999 St. Paul Technical College St. Paul, MN
Business of Cosmetology
Certification in Cosmetology
G.P.A 4.0
1989 - 1993 Carl Schurz High School Chicago, IL
Business Administration
Diploma Received
G.P.A 3.0
Employment: 5/2006- 5/2009 Hennepin
County MHP Dept. Mpls, MN
Care Management Coordinator Assistant FT
Performed Non-Clinical Utilization Reviews (UR) with
in the Medical Administration Dept. for Metropolitan
Health Plan (MHP) a non-profit HMO. Entering data to
create authorizations requests for Providers
(Inpatient and Outpatient), Personal Care Attendant
(PCA) and Skilled Nurse Facilities/Nursing
Facilities (SNF/NF) which based in clinics,
hospitals and nursing homes so they can be paid for
services. Reviewing Member's benefits and make
certain that their insurance is effective. Also,
modifying Inpatient and SNF/NF Facilities admissions
and discharges dates of services by entering data
into Care enhance Clinical Management Software
(CCMS) system and create CSR's (Customer Service
Response) in IDX data system. In addition to SNF/NF
services, checking benefits with in CCMS and
Department of Human Services/MNITS (DHS) to see if
Member(s) are Qualified Medicare Beneficiary and/or
to see if the Member(s) Insurance plan is
responsible for payment for NF when receiving
Pre-Paid Medical Assistance Program (PMAP)
Communication Form on date of admission to Nursing
Home. Also entering data from PMAP Communication
Form that states which services where, provided to
Member by the given case mix (Medicaid), rug scores
(Medicare) and calculating benefits days that the
Insurance plans covers.
Performed as lead and as well work with other Care
Coordinator Asst. and/or Nurses.
Trained new employees to software and Dept workflow.
Answering inquiries via phone/fax based on which
type of services needs to be authorized, decipher
units for PCA and/or days for SNF/NF of care for
Nursing Homes and if Member's have effective
benefits.
Perform multi-duties for Nurses such as; Sorting and
attaching faxes to Member's profile. Creating events
in CCMS for review and sending notification letters
to Providers/Members informing rather service has
been approved or denied.
11/2005 - 5/2006 Hennepin County MHP Dept. Mpls, MN
Member Service Representative FT
Answering inquiries via phone based on North Star
Advantage and North Star Advantage Plus Medicare
plans.
Explaining the differences and similarities between
North Star Advantage and North Star Advantage Plus
Medicare Health Plans.
Discussing the Summary of Benefits including
co-pays, premium costs and the type of prescription
drugs covered under plans and giving the location
and name of pharmacies provided under Medicare
Prescription Drug Plans.
Entering data in to Share point filing System,
Requesting North Star Advantage and North Star
Advantage Plus Medicare material to be sent out to
prospect Clients.
01/2000 - 05/2009 New Wave Hairstylist
Mpls, MN
Professional Hairstylist PT
Process customer's appointments by scheduling them
to receive services.
Answered any inquiries via telephone, email and in
person due to the type of services performed at the
salon.
Indicate my consideration base on ideas and
customers concerns for the care of their hair and on
how well to maintain the health of their hair.
Updating client's info in filing system by using
Microsoft Publisher. Creating documents/coupons and
sending them by postal mail and via email due to any
updates/changes that has been made at the salon.
Contact this candidate