Customer Service Representative
Resume:
Mariette Cassada Longmeadow, MA
ac2awe@r.postjobfree.com 860-***-****
PROFILE: Office & Administrative Support.
PROFESSIONAL SUMMARY: Office Assistant/Manager with significant experience in healthcare including insurance claims and hospital settings. Expertise in office operations, documentation and charting, claims analysis. Excellent customer service and patient interaction skills, strong technical skills. Seeking office or administration support role in healthcare setting.
SKILLS:, MS Word, MS Excel, MS PowerPoint, MS Outlook, Adobe Reader, Internet Research. Medical Terminolog, charting.
HIPAA training, claims Analysis, STD, FMLA. Better Business Writing, The Essentials of Life and Accident and Health Insurance, Interpreting Medical Reports. CPR certified.
PROFESSIONAL EXPERIENCE:
TSR Consulting / (Chubb Insurance Co.) Simsbury, CT (Contract) August 2017 – September 2017
Claims Assistant
Enter claims in system, index claims, code claims, determine claim type, determine claim date of loss, attach the correct policy to the claim, route claims to Claims Manger.
Sun Life Financial Windsor, CT May 2016 – April 2017
Case Specialists 1 / FMLA & Short Term Disability
Reviews claim payments within established limits and/or reviews recommendations made by medical resources to determine proper disposition of claims. Set claim action plan to ensure that determinations are adjudicated in a timely, accurate, and efficient manner.
Interprets contracts and ensures consistent, fair claims practices and adherence to appropriate laws, regulations, and procedures.
Obtains backup documentation, as necessary, to substantiate claim or to provide service by communicating via telephone with agents, employers (policyholders), claimants, hospitals, physicians, attorneys, and other resources.
Handle other related duties such as providing technical assistance to other Claims staff or assisting in special projects or assignments as a result of business needs.
Assisted with special project in the Operational Claims department.
Acadia HealthCare (Habit OPCO) Springfield, MA February 2016 – May 2016
Office Assistant / Scheduler
Check patients in. Inform clinician’s of patients arriving. Answer phone calls. Have patients sign electronic Release of Information forms, Authorization forms and appointment letters. Schedule doctor and Medical Director appointments. Handle swab testing/drug testing on patients. Handle new patient intakes. Call patients when they are no shows. Take and post patient payments.
Run reports, assist in Medical Records Dept filing and auditing charts.
Travel Insured International Glastonbury, CT November 2011 – February 2016
Claims Analyst
Obtain information required to effectively evaluate claim decisions regarding the acceptance or denial of travel insurance claims. Issue payments to insured’s when applicable or write send denial letter.
Review coverage and provisions under a insured’s plan.
Answer calls and assist customer service when needed and document notes in the system.
POMCO Group W Springfield, MA April 2010 – October 2010
Customer Service Representative (This location officially closed)
Answer incoming calls regarding health insurance benefits, eligibility, prior auth and claim status
Document all calls in system
Issue coordination of benefit letters
Send Explanation of benefits when requested
Review and research complicated claims and handle difficult and irate calls
Dominion Enterprises Danbury, CT July 2005 –September 2009 (This location officially closed)
Field Rep/Merchandiser
Travel to multiple stores throughout CT and MA for inventory, maintenance and delivery of free publications.
Log and report violators.
Hartford Hospital 2001 - July 2005
Joshua Center-(Natchaug Hospital affiliate) Enfield, CT
Office Manager
Record census/attendance for Clinical Day Treatment, Partial Hospitalization Program and Intensive Outpatient Program.
Balance, calculate and request reimbursement for bi-weekly petty cash.
Put new patient charts together and take apart discharged patient charts and audit charts.
Verify insurance eligibility and benefits. Transcribe discharge summaries.
Complete weekly and monthly statistics report. Order office supplies and food supplies.
Handle all transportation calls. Type letters for PPT’s and point graphs in Excel.
Set up patient appointments. Audit charts. Answer all incoming calls and greet all visitors.
Health Information Analyst Hartford, CT
Log in medical records request received from patients, Attorney’s, insurance companies and health facilities.
Request medical charts, print medical records from imaging and call other departments to retrieve additional records if needed.
Review authorization for compliance.
Review charts and imaging to release only the information requested.
Mark charts to forward to the copy department.
Log out request in system and bill the appropriate parties for records.
Customer Service Representative - Behavioral Health CT department Newington, CT
Provide registration for outpatient behavioral health to participating Aetna and MedSpan providers and out-of-network providers. Advise Aetna members of claim status.
Provide referral assist to members and participating behavioral health providers.
Quote in-network and out-of-network benefits and eligibility for Aetna members.
Confirm registration dates and extend registrations when requested by provider.
Advise Aetna members of claim status.
Mass Mutual Hartford, CT 2000 – 2001
Disability Income Claim Examiner
Obtain information required to effectively evaluate claim decisions regarding the acceptance or denial of a disability income, business overhead expense and premium wavier.
Analyze information and interpret policy provisions to appropriate claims decision.
Manage caseload to provide accurate and timely benefit payments on all eligible claims.
Correspond with insured’s, physicians, employers and attorneys.
MetLife Glastonbury, CT 1997 -2000
Case Manager
Investigation and review for payment and decision of Total and Permanent, Continued Protection and Continuation of Life Insurance.
Review coverage and provisions under a member’s plan.
Utilize system to enter in new claims, obtain record claim information and for follow-up.
Obtain medical information. Correspond with claimants, physicians, employers and attorneys.
Cigna HealthCare 1994 - 1996
Customer Service Representative (This location officially closed)
Answer inquiries from members, providers, policy holders, sales and others regarding benefits, services and general processing status on all related inquires.
Resolve member or provider complaints, concerns and questions directly through coordination and follow-up with other departments within Cigna.
Educate members and providers on administrative procedures.
Assist as back up team leader when needed.
EDUCATION:
Fermi High School. Enfield, CT
High School diploma
Major: Business
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