Customer Service Representative

Carl Andrews

Yeadon, PA *****

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

Authorized to work in the US for any employer

WORK EXPERIENCE

Credit Revenue Specialist

Exelon Corporation - Philadelphia, PA - 2013 - Present duties: Evaluate and process customers' request for various types of payment arrangements and extensions offered based on the customers' income and household. Apply and transfer credits and debits to accounts. Evaluate and process, as appropriate, accounts to determine if eligible for late fee waivers and credits or refunds of security deposits. Interact with various departments to assist with accounts' resolutions. Adhere to Credit, Collections, Bankruptcy, Low-income and PUC Chapter 56.0 policies. Process verification of customer's incomes. Effectively process up to 200 accounts per day in the Customer Information Management System

(CIMS)

position: Universal Service Project (Dispute Team) Exelon Corporation - Philadelphia, PA - duties: Resolved disputes and escalations for CAP FCO Program • Advised customers of all resources available in Universal Service (Liheap Meaf, Liurp, Crisis) • Reviewed CAP credits with customers • Reviewed customer accounts position: Revenue Management Department-( Name Game Representative) duties: Prevent potential customers from fraudulently obtaining electric/gas services that already benefited from the services from that property and eluding paying a high balance that was created from that property when they were already living there with the previous account holder. Check the financial statement to see if applicant is on the financial statement. Check Lexus Nexis for verification of documents sent by the customer. Check the ownership of property in Lexus Nexus-if name is different, check the county database for recent home purchases. Check validity of lease-look for areas that might have been altered. Call the owner to see if applicant is a new resident. Determine if current rate payer is still at the property. Send denial letters if they are denied for any of the criteria's that are found to be violations in Name Game. Process electric/gas connects for service, go out of Customer Information Management System (CIMS) and then back in to make certain that the connect went through for approved services.

Customer Service Representative/Call Center Representative

- 2012-10 - 2013-01

duties: National Accounts Family Summary/Mission To increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes. Position Summary/Mission Handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature. Fundamental Components & Physical Requirements include but are not limited to denotes essential functions. Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. Explains member's rights and responsibilities in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates providers on our self-service options; Assists providers with credentialing and re- credentialing issues. Responds to requests received from Client's Law Document Center regarding litigation; lawsuits. Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/ deductible. Performs financial data maintenance as necessary. Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. Ability to multi-task to accomplish workload efficiently. Analytical skills. Ability to maintain accuracy and production standards. Technical skills. Oral and written communication skills. Understanding of medical terminology. Problem solving skills. Attention to detail and accuracy. Negotiation skills.

Customer Service Representative/Call Center Representative XEROX/AFFILIATED COMPUTER SERVICES - 2011-09 - 2011-11 duties: Responsibilities were responding to customer inquiries and answering inbound phone calls regarding health and welfare benefits.

Medical Management Specialist/ Customer Service

ERIE INSURANCE COMPANY - 2009-12 - 2010-12

duties: Responsible for determining coverage, checking deductibles, prompt investigation of liability, damages and subrogation for possibility of assigned claims. Response for ICD-9 and CPT-4 CONTRACT EMPLOYEE

VARIOUS EMPLOYERS - 2008-02 - 2009-12

No-Fault Claims Specialist/Customer Service

LIBERTY MUTUAL INSURANCE COMPANY - 2006-06 - 2007-06 duties: Responsible for determining coverage, checking deductibles, prompt investigation of liability, damages and subrogation for possibility of assigned claims. Response for ICD-9 and CPT-4 coding, determine if injuries are accident related. Developing claim files on losses assigned and document all transactions related to the file handling, reporting progress and results. Evaluate claims and conduct negotiations with claimants, physicians and attorneys. Knowledge of state laws, Insurance Laws, and Unfair Claims Practice Acts. Knowledge of Med-Pay/PIP Coverage and statutes. Understanding of Medical Terminology and the ability to Interpret Medical reports and records. Respond to claim handling inquiries from agent review claims paid by agents for errors and overpayments. Effectively apply analytical, organizational, telecommunications, computer applications, negotiating and problem solving skills. Applying the necessary skills of claim handling in the States of NJ, PA, Average Pending: 275 to 300. Average New Claims: 9-15. Handled catastrophic losses up to millions of dollars. No-Fault Claims Specialist/Customer Service

VARIOUS EMPLOYERS - 2003-09 - 2006-12

duties: Responsible for determining coverage, checking deductibles, prompt investigation of liability, damages and subrogation for possibility of assigned claims. Response for ICD-9 and CPT-4 coding, determine if injuries are accident related. Developing claim files on losses assigned and document all transactions related to the file handling, reporting progress and results. Evaluate claims and conduct negotiations with claimants, physicians and attorneys. No-Fault Claims Representative/Customer Service

AAA MID ATLANTIC INSURANCE GROUP - 2001-12 - 2003-03 duties: Same duties as above handling the State of PA. Pending: 275. New Claims: 15/month.

CONTRACT EMPLOYEE

VARIOUS EMPLOYERS - Washington, DC - 2000-07 - 2001-12 position: No-Fault Claims Representative/Customer Service duties: Handling the State of New Jersey primarily. In addition handled the States of PA, NY, AL, AK, AZ, CA, CO, CT, DE, Wash. D.C., FL, GA, HI, ID, IN, IL, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NM, NC, ND, OH, OK, OR, PR, RI, SC, SD, TN, TX, UT, BT, VI, VA, WA, WV, WY, & WI.

EDUCATION

Certificate in Computer Operations

The Institute of Business and Technology

1986-02 - 1986-09

Liberal Arts

Community College of Philadelphia

1983-09 - 1985-12

SKILLS

CIMS, Tracker, Oracle Microsoft

ADDITIONAL INFORMATION

Certificate in Computer Operations

Certificate in Interpreting Medical Reports

Certificate in Legal Concepts & Doctrine

Certificates in Customer Service

Delaware Adjuster’s License

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