Customer Service Representative

**** *** ** *******, ** ***** 256-***-**** abk0zf@r.postjobfree.com

Annette Watson

Objective To contribute as a team player to provide a

superior product and to exceed business goals and

expectations.

Experience 2010-2010 Perot Systems/ MVP Health Care

Albany, NY

Customer Service Representative

Handled inbound calls for provider services claim

status.

Handle in bound calls for provider benefits and

eligibility

Maintained high average hold time and adherence

average.

2009- 2009 West Corporation/Pacific Care

Huntsville, AL

Customer Service Representative

Handled inbound calls for PPO, HMO, POS, EPO and

Commercial plans.

Verified eligibility, benefits and claim status.

Resolved claims, capitation, Primary Care Physician

panel issues.

2009-2009 Perot Systems/ Blue Cross

Denver, CO

Customer Service Representative

Handled inbound calls for provider benefits and

eligibility.

Handled inbound calls for provider claims status.

Maintained correspondence and claim pending files.

2008-2008 Perot Systems/ Blue Cross

Little Rock, AR

Medical Claims Examiner

Adjudication and resolution of complex claims.

Investigated and resolved all claims payment and

denial issues.

Worked on project to successfully eliminate a

44,000 claims back log in 2 months.

2005- 2007 Peach State Health Plan

Atlanta, GA

Provider Service Representative

Served as liaison between providers, members and

health plans

Investigated and resolved all claims payments and

denial issues.

Verified eligibility, benefits, enrollment and

claim status.

1999- 2005 MedAdmin Solutions

Atlanta, GA

Medical Claims Examiner

Adjudication of medical and dental claims.

Evaluated claims for correct coding.

Resolved all claims and customer service issues.

Education Bachelor of Science - Tennessee State University,

Nashville, TN

.

Systems AMYSYS, AMYSYS ADVANCE, DIAMONDS, DIAM COM, MACESS

Experience GEMS, ASA, ERISCO, RIMS, ITS, IDT, RESOLUTION,

NICE, ILIAD, DOS, WEBSERIES, CLAIMS EXCHANGE, REVA,

IMAGINING, WSG CALL CARE BROWSER, FACESS.

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