Customer Service Insurance

To Rhonda Johnson

P.O. Box ******

Dallas, TX ***74

214-***-**** (cell)

*******@*********.***

Accomplished professional with more than 15 years experience within the

Insurance Industry. Experience working with Accidental and Occupational

claims and Credit Life and Disability Claims. I have the know-how in multi-

tasking, organizing and team-building. Special areas of concentration:

Customer Service in Call Center Environment

Database Management

Claims Processing and Investigations

PROFESSIONAL EXPERIENCE

Dearborn National Life Insurance, Dallas, TX

SR. CLAIMS CUSTOMER SERVICE REPRESENTATIVE (June 2008 to December 2012)

Maintain a high-level of Customer Service working with Group Life,

Individual Life, STD and LTD claimants and policyholders. Duties included

maintaining Customer Service Email box, Telephonic Claims Intake and

handling Escalated calls as needed. Call Center calls consisted of frequent

communication with attorneys, Group representatives, Claimants, State

agencies such as ERS and U.T., reinsurers and other insurance companies to

exchange claim information via telephone as well as email transmission.

Special Insurance Services, Dallas, TX

CLAIMS EXAMINER (November 2005 to May 2008)

Adjudicated intercollegiate benefit claims and processed medical claims for

payment. Requested all information as needed from internal or outside

sources to ascertain completeness and validity of claim; including the

coordination of benefits information. Analyzed and answered inquiries

regarding claim adjudication, including method of payment, co-pay or

deductible amounts, and/or reason for denial. Utilized CPT codes and other

payer codes and researched claims as needed and responsible for

correspondence.

ELIGIBILITY SPECIALIST (June 1992 to March 1999)

Interpreted policyholder's policies and plans by maintaining claim records.

Verified group and individual enrollment through premium verification and

policyholder's records to establish an enrollees benefit under either the

Occupational Plan or ERISA Plan. Responsible for training all new

Eligibility Specialist and monitored on a regular basis Provider's Tax

Identification Numbers according to established guidelines. Assisted in the

conversion of a new Claims System and trained as an Underwriting Clerk.

Served as a back-up to Customer Service and processed premium as an Account

Payable Clerk.

CLAIMS ADMINISTRATOR

Reviewed claim forms for completeness, transmitted reports, insurance

claims information, physician statements for disability and medical bills

for payment to the Insurance Carrier. Responsible for corresponding and

answering inquiries regarding claim adjudication, including method of

payments and maintained claims records. Maintained claim files for the

Claim Department.

Resource Life Insurance subsidiary of Aon, Inc., Dallas, TX

CLAIMS ANALYST (March 1999 to May 2005)

Acquired by Cambridge Integrated Company

Investigated Short and Long Term Disability claim payments against the

terms and provision of the Certificate of Insurance. Conducted telephone

interviews with insured in order to determine return to work status,

gathered medical records and physician reports to establish the extent of

company liability. Recommended files for Legal Review and Management

Review. Negotiated insured's accounts back into good standing. Responsible

for answering any inquiries regarding claim decisions and coordinated

correspondence.

Sears Logistics Services, Dallas, TX

LOGISTICS CONSULTANT (October 1991 to August 1992)

Dispatched drivers to customer's home and prepared special handling

instructions for delivery drivers. Checked inventory for Sales Associates

and conducted customer inquiries.

SJA Brokerage, Dallas, TX

LICENSING SPECIALIST (September 1988 to December 1990)

Acquired by USI, Inc.

Maintained agent information for licensing purposes and collected licensing

fees. Monitored and reviewed licensing renewals for company producing

agents. Managed agent hierarchy for commission purposes and Marketing

support.

EDUCATION/CERTIFICATIONS

Dallas Baptist University, Dallas, TX

Graduated: May 2002

Healthcare Administration/Business Administration

Texas Property and Casualty Adjuster Certificate of Completion 2008

LOMA (Life Office Management Association, Inc.) certificate 280 and 290

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