Customer Service Insurance

Philshayla Nash

**** *. ********* **. 909-***-****

Ontario, CA 91764 abk3hq@r.postjobfree.com

Customer Service Professional

Customer Service Professional with seven years experience working for a

nationally recognized, fortune 500, insurance carrier. Outstanding ability

to multi-tasks and meet critical deadlines. Proven ability to effectively

interface with internal and external customers. Outstanding business

communication skills both verbal and written. Recognized for having

exceptional customer relations and interpersonal skills.

. Proficient in T-MATE, HOST Sessions, Claim Notes applications

. Microsoft Word, Excel, and Outlook

. Strengths in listening, evaluating and problem solving

. Well developed organizational skills

. Loyal, driven, honest and committed to a job well done

. Exposure to Workers Compensation and Liability

Professional Experience

Anthem BlueCross (WellPoint, Inc.), Pomona, CA

Customer Care Representative

2009-Current

. Responds to customer questions via telephone and written correspondence

regarding insurance benefits, provider contracts, eligibility

and claims.

. Analyzes problems and provides information/solutions.

. Operates a PC/image station to obtain and extract information; documents

information, activities and changes in the database.

. Thoroughly documents inquiry outcomes for accurate tracking and analysis.

. Develops and maintains positive customer relations and coordinates with

various functions within the company to ensure customer requests and

questions are handled appropriately and in a timely manner.

. Researches and analyzes data to address operational challenges and

customer service issues.

. Provides external and internal customers with requested information.

. Under immediate supervision, receives and places follow-up telephone

calls / e-mails to answer customer questions that are routine in nature.

. Uses computerized systems for tracking, information gathering and

troubleshooting.

. Requires limited knowledge of company services, products, insurance

benefits, provider contracts and claims.

. Seeks, understands and responds to the needs and expectations of internal

and external customers

Travelers Insurance, Diamond Bar, CA 2002-2009

Workers Compensation Team Professional (Medical Dept)

. Provided administrative and technical support to Medical Case Managers.

. Effective contacted employers to obtain restrictions available at the

initial creation of a case.

. Verified return to work per SAC instructions.

. Obtained specific medical information from the most recent office visit

and dates of procedures already reviewed and approved.

. Contacted therapy providers to obtain the initial evaluation and followed-

up progress reports.

. Reviewed and followed-up on physical therapy as well as followed-up on

surgery discharges.

Travelers Insurance, Diamond Bar, CA

(Initially came to Travelers through Manpower) 2002

Customer Service / Mailroom

. Opened IQ, distributed, and attached mail for case managers.

. In charge of file backs as well as retrieving files.

. Handled Work Comp and Liability mail.

. Rerouted calls to claim adjusters

El Seron House, Chino, CA 2001

Home Health Aide

. Assisted physically disabled persons with everyday living.

. Served meals, maintained household.

. Provided assistance with client finances.

Volunteer Experience

Salvation Army Hospitality Shelter

Certification and Professional Development

Continuing Education:

HIV/AIDS Education, First Aid & CPR, Dealing with Dementia

Basic Human Needs, Basic Nutrition, Body Mechanics, Resident Abuse

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