Customer Service Representative

Teresa Ross

***** ********** ***** *********, ** 28215

Home 704-***-**** Cell 843-***-****

E-mail Address: ************@*****.***

Objective:

To use my skills and knowledge obtained through my education and work

experience as a customer service representative to support the growth of

this company.

Professional Experience

Palmetto Government Benefit Administrators Florence, SC - Michigan Med

Advantage

January 2007- Present - Customer Service Representative III

1. Researches and respond to priority or highly complex inquiries and

complaints, ensuring that contract standards and objectives for

inform cycle time, quality and productively are met.

2. Consistently exceed 100% production and quality standards o meet

contractual agreements.

3. Train new employees in area including but not limited to progressive

modular training and current job responsibilities.

4. Update Blue Cross Blue Shield of Michigan members benefit coverage in

CES.

5. Respond to informs from customer service representatives concerning

adjustments/reprocessing of claims.

6. Detail knowledge of Medicare Advantage and PIMS systems CPT-4 and ICD-

9 coding and all claims processing functions, procedures and

workflow.

7. Run DB2 queries and provide reports on data. Use clinical coding

expert and BCBSM pricers to price claims.

8. Provide necessary feedback to area manager on routine basis.

PGBA - Florence, SC- Tricare Division

March 2004- January 2007 - Claims Associate III

9. Received incoming and outgoing calls to doctors, health benefit

advisors and military personnel.

10. Process and adjust military claims. Research and respond to

correspondence from health benefit advisors and doctors.

11. Identified and report potential fraud and abuse situations to program

integrity.

12. Interviewed applicants for customer service representative positions

within the contract.

PGBA- Florence, SC - Tricare Division

February 2002 - March 2004 - Claims Associate II

13. Research and process active duty military insurance claims.

14. Provide necessary feedback to area manager on routine basis.

PGBA- Florence, SC - Tricare Division

July 1996 - February 2002 - Workflow Clerk

15. Order office supplies.

16. Issued work to associates daily.

17. Assist manager when need.

Education-

Mayo High School Darlington, SC 29532 - 1992- 1995 High School Diploma

Company Achievements Certifications include: Certified customer service

representative, Introduction to DB2/QMF/SQL for non programmers, Adapting

to Change.

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