Customer Service Insurance
Resume:
EARL REDD JR.
*******@*****.***
SUMMARY:
** ***** ** ********** ******* in customer service, sales and management. I am looking for a position where I can utilize
my skills, to help increase the company’s overall goals; as well as learn new skills. I have a proven ability to meet and
exceed all performance objectives.
EDUCATION:
Baker College - Allen Park, MI 06-09 - Present
Associate of Applied Science, Computer Networking Technology- Cisco Option
EXPERIENCE:
TOWERS WATSON – Southfield, MI 10/12 – 12/12
Pension Administration Analyst (OFFICE TEAM TEMP)
• Reviewed pension and lump sum payment kits for errors and omissions or missing forms, approved kits that were
correct and completed to secondary checkers for approval
• Created correction letter and mailed the incomplete or missing forms to the participant to fill out and return
• Completed entry of data into proprietary software system
• Assisted Consultants in the Pension Administration Group (PAG)
• Followed up with clients via written communication, to ensure all information was correct
• Reviewed and corrected internal errors, to ensure 100% compliance with quality standards
• Delivered project cases and kits to meet or exceed client expectations
• Increased efficiency within client teams by identifying ways to improve processes
XEROX CORP (FORD), Allen Park, MI 04/12 – 08/12
Pension Benefits Representative (BARTECH TEMP)
• Advised employees on wide range of global structure benefits such as; Short/Long term disability, retirement,
pension payroll functions and health care benefits
• Counseled plan participants on disability benefits and how it may impact pension benefits
• Conducted problem-solving consultation in accordance with company guidelines
• Interacted with Union Benefit Representatives, Labor Relations and Benefit Carriers, Attorneys, Medical
Insurance and Vendors to resolve/prevent issues
• Educated active hourly and salaried employees/retirees about qualified and non-qualified retirement plans
• Reviewed, calculated and submitted Disability Retirements for approval by the UAW Retirement Board and/or the
General Retirement Committee
J & B MEDICAL SUPPLY – Wixom, MI 12/11 - 2/12
Insurance Verification Representative (Temp call center)
• Handled incoming calls, company voice mails regarding new and existing client’s or caregiver’s various requests
such as holding, increasing, decreasing, removing, restarting, shipping issues and changing of supplies to and
from the monthly work order
• Determined if client could be serviced and confirmed that the client is correctly assessed for the amount of
products on RWO using PCU and CMN guidelines
• Updated demographic information on account, including addresses, phone number, physician information and
caregiver name
• Transferred or tasked clients/cg to the verification team for requests of insurance updates, new script forms or
questions regarding urological supplies, restarting accounts or verification of valid prescriptions
• Verified insurance eligibility for Medicaid via Champs, EVS or Forward Health
CATALYSTRX – Lansing, MI 09/10 - 05/11
Pharmacy Technician
• Handled inbound and outbound calls, providing outstanding customer service and ensuring that customer service
goals are met
• Communicated accurate information to members regarding prescription benefit plans, including co-pay
information, plan design, participating pharmacies, medication alternatives, and other related member questions
• Assist Pharmacists with claims processing, giving correct information for proper adjudication of prescriptions
• Processed medication overrides to allow payment of vacation, lost/stolen, or spilled medication
• Analyzed, evaluated, and resolved inquiries in a concise and accurate manner
• Exhibited compliant and ethical behavior in the performance of job responsibilities, including: complying with all
applicable federal and state laws and regulations, Catalyst Health Solutions Code of Conduct, Business Ethics
Policies and Procedures and other policies and procedures applicable to the position
BLUE CROSS BLUE SHIELD, DETROIT MI 08/06 – 9/10
Customer Service Rep II
• Analyzed, evaluated, and resolved provider inquiries received via telephone, correspondence or in person
involving a variety of claim/benefit issues under product lines, directed the adjudication of claims and inquiries
• Conducted internal and external research necessary to resolve inquiries from providers
• Responded to provider via telephone, handwritten/check-off letters, or by typewritten self-composed letter in a
manner so as to influence the provider to accept the reasonableness of decisions and actions
• Initiated status reports to the inquirer when delays occur in responding to any inquiry
• Organized work to meet National, Corporate, Department production and quality standards also followed
Department, Corporate reporting requirements
• Interacted with departmental and corporate personnel as well as others outside the organization to resolve any
inquiry or claim-related problems
• Assisted other representatives and handled unusual or complex inquiries, including irate callers as well as those
inquiries that may have an impact on the retention of a group, contract or provider
TITAN INSURANCE (A DIVISION OF NATIONWIDE) – Troy, MI 10/04 – 06/06
Senior PL Representative
• Performed accurate payment transactions, via credit card, check, and phone
• Functioned as liaison between Titan members and internal departments to resolve sales and service issues
• Followed internal processing procedures to ensure that business is handled in accordance with established
company policies and procedures
• Participated in, and coordinated special projects; including, company training and creating strategies to increase
overall productivity in the department
• Balanced computer RPS and receipt books daily
SKILLS:
• Knowledge of Benefit screens CRT displays, History files, Subscriber files, and all Master/Major Medical
displays, NASCO, IRIS, OLR, 3270, Outlook and most of the forms and programs used to give concise
information and adjust claims via PCA
• Working Knowledge of Microsoft Word, Excel, Outlook and Windows XP, NT and Vista, windows 7
• EEpoint, Citrix, Statestreet bank and all screens related to pension processing
VOLUTNEER AFFILIATIONS:
• Active member of Quality Council
• Member of Member Service Center Mentoring Program
• Member of the Top Ten Producers Club
• Licensed to sell Life Insurance, via State of Michigan
Contact this candidate