Customer Service Representative
Resume:
RUTHIE N. JACKSON
*** ****** **. ***# ** New York, NY 10027
Cell: 929-***-**** **********@*****.***
OBJECTIVE: Experienced claims representative with strong organization, communication, and analytical
skills seeking a position with Columbia Presbyterian as an Insurance Claims Representative.
EDUCATION
TECHNICAL CAREER INSTITUTE NEW YORK, NY
DEGREE OBTAINED: A.A.S BUSINESS ADMINSTRATING ACCOUNTING - DECEMBER 2009
SKILLS
• Customer Service, Claims Service
• Computer: Spreadsheet, Word Processing, Database Management
• MS Office: Word, Excel, PowerPoint
• Organizational Skills, Multi-tasking, Communication, Teamwork PROFESSIONAL EXPERIENCE
CLAIMS SERVICE
REPRESENTATIVE/ADJUSTER MAY
2016 – PRESENT
METROPLUS HEALTH PLAN NEW YORK, NY
• Respond to all claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators
• Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., claims, Utilization Management)
RUTHIE N. JACKSON
503 W133rd St. Apt# 5C New York, NY 10027
Cell: 929-***-**** **********@*****.***
OBJECTIVE: Experienced claims representative with strong organization, communication, and analytical
skills seeking a position with Columbia Presbyterian as an Insurance Claims Representative.
EDUCATION
TECHNICAL CAREER INSTITUTE NEW YORK, NY
DEGREE OBTAINED: A.A.S BUSINESS ADMINSTRATING ACCOUNTING - DECEMBER 2009
SKILLS
• Customer Service, Claims Service
• Computer: Spreadsheet, Word Processing, Database Management
• MS Office: Word, Excel, PowerPoint
• Organizational Skills, Multi-tasking, Communication, Teamwork PROFESSIONAL EXPERIENCE
CLAIMS SERVICE
REPRESENTATIVE/ADJUSTER MAY
2016 – PRESENT
METROPLUS HEALTH PLAN NEW YORK, NY
• Respond to all claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators
• Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., claims, Utilization Management)
RUTHIE N. JACKSON
503 W133rd St. Apt# 5C New York, NY 10027
Cell: 929-***-**** **********@*****.***
OBJECTIVE: Experienced claims representative with strong organization, communication, and analytical
skills seeking a position with Columbia Presbyterian as an Insurance Claims Representative.
EDUCATION
TECHNICAL CAREER INSTITUTE NEW YORK, NY
DEGREE OBTAINED: A.A.S BUSINESS ADMINSTRATING ACCOUNTING - DECEMBER 2009
SKILLS
• Customer Service, Claims Service
• Computer: Spreadsheet, Word Processing, Database Management
• MS Office: Word, Excel, PowerPoint
• Organizational Skills, Multi-tasking, Communication, Teamwork PROFESSIONAL EXPERIENCE
CLAIMS SERVICE
REPRESENTATIVE/ADJUSTER MAY
2016 – PRESENT
METROPLUS HEALTH PLAN NEW YORK, NY
• Respond to all claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators
• Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., claims, Utilization Management)
RUTHIE N. JACKSON
503 W133rd St. Apt# 5C New York, NY 10027
Cell: 929-***-**** **********@*****.***
OBJECTIVE: Experienced claims representative with strong organization, communication, and analytical
skills seeking a position with Columbia Presbyterian as an Insurance Claims Representative.
EDUCATION
TECHNICAL CAREER INSTITUTE NEW YORK, NY
DEGREE OBTAINED: A.A.S BUSINESS ADMINSTRATING ACCOUNTING - DECEMBER 2009
SKILLS
• Customer Service, Claims Service
• Computer: Spreadsheet, Word Processing, Database Management
• MS Office: Word, Excel, PowerPoint
• Organizational Skills, Multi-tasking, Communication, Teamwork PROFESSIONAL EXPERIENCE
CLAIMS SERVICE
REPRESENTATIVE/ADJUSTER MAY
2016 – PRESENT
METROPLUS HEALTH PLAN NEW YORK, NY
• Respond to all claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators
• Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., claims, Utilization Management)
RUTHIE N.pdf
Saved to Dropbox • Aug 30, 2017, 6 31 PM
• Perform claim adjustments to correct erroneous
payments(overpayments/underpayments)
• Manage and ensure appropriate follow-up and closure for all inquiries
• 3M Group Pricing
• Participate in Special Projects involving claims status investigation CUSTOMER SERVICE REPRESENTATIVE
JULY 2014 – MAY2016METROPLUS HEALTH PLAN NEW YORK, NY
• Provided comprehensive customer service to members, providers, and prospective members.
• Documented all customer contacts into tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientation, claims review inquiries, and handle provider inquiries
• Responded to all billing and claim inquiries from providers and members
• Provided on-site as well as telephone orientation to new and existing members.
• Provided all benefit service related information to members and providers
• Updated all members demographic changes
• Listened attentively to caller needs to ensure a positive customer experience
LICENSE MEDICARE ADVANTAGE SALES AGENT/CUSTOMER SPECIALIST AUGUST 2011 – JULY 2014
AEGIS COMMUNICATIONS NEW YORK, NY
• Responded to inbound customer inquiries using an effective consultative selling approach by asking appropriate questions and matching the right product to the customer’s needs, resulting in closed sales as well as increased customer satisfaction.
• Identified, investigated, and resolved customer complaints and concerns
• Perform claim adjustments to correct erroneous
payments(overpayments/underpayments)
• Manage and ensure appropriate follow-up and closure for all inquiries
• 3M Group Pricing
• Participate in Special Projects involving claims status investigation CUSTOMER SERVICE REPRESENTATIVE
JULY 2014 – MAY2016METROPLUS HEALTH PLAN NEW YORK, NY
• Provided comprehensive customer service to members, providers, and prospective members.
• Documented all customer contacts into tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientation, claims review inquiries, and handle provider inquiries
• Responded to all billing and claim inquiries from providers and members
• Provided on-site as well as telephone orientation to new and existing members.
• Provided all benefit service related information to members and providers
• Updated all members demographic changes
• Listened attentively to caller needs to ensure a positive customer experience
LICENSE MEDICARE ADVANTAGE SALES AGENT/CUSTOMER SPECIALIST AUGUST 2011 – JULY 2014
AEGIS COMMUNICATIONS NEW YORK, NY
• Responded to inbound customer inquiries using an effective consultative selling approach by asking appropriate questions and matching the right product to the customer’s needs, resulting in closed sales as well as increased customer satisfaction.
• Identified, investigated, and resolved customer complaints and concerns
• Perform claim adjustments to correct erroneous
payments(overpayments/underpayments)
• Manage and ensure appropriate follow-up and closure for all inquiries
• 3M Group Pricing
• Participate in Special Projects involving claims status investigation CUSTOMER SERVICE REPRESENTATIVE
JULY 2014 – MAY2016METROPLUS HEALTH PLAN NEW YORK, NY
• Provided comprehensive customer service to members, providers, and prospective members.
• Documented all customer contacts into tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientation, claims review inquiries, and handle provider inquiries
• Responded to all billing and claim inquiries from providers and members
• Provided on-site as well as telephone orientation to new and existing members.
• Provided all benefit service related information to members and providers
• Updated all members demographic changes
• Listened attentively to caller needs to ensure a positive customer experience
LICENSE MEDICARE ADVANTAGE SALES AGENT/CUSTOMER SPECIALIST AUGUST 2011 – JULY 2014
AEGIS COMMUNICATIONS NEW YORK, NY
• Responded to inbound customer inquiries using an effective consultative selling approach by asking appropriate questions and matching the right product to the customer’s needs, resulting in closed sales as well as increased customer satisfaction.
• Identified, investigated, and resolved customer complaints and concerns
• Perform claim adjustments to correct erroneous
payments(overpayments/underpayments)
• Manage and ensure appropriate follow-up and closure for all inquiries
• 3M Group Pricing
• Participate in Special Projects involving claims status investigation CUSTOMER SERVICE REPRESENTATIVE
JULY 2014 – MAY2016METROPLUS HEALTH PLAN NEW YORK, NY
• Provided comprehensive customer service to members, providers, and prospective members.
• Documented all customer contacts into tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientation, claims review inquiries, and handle provider inquiries
• Responded to all billing and claim inquiries from providers and members
• Provided on-site as well as telephone orientation to new and existing members.
• Provided all benefit service related information to members and providers
• Updated all members demographic changes
• Listened attentively to caller needs to ensure a positive customer experience
LICENSE MEDICARE ADVANTAGE SALES AGENT/CUSTOMER SPECIALIST AUGUST 2011 – JULY 2014
AEGIS COMMUNICATIONS NEW YORK, NY
• Responded to inbound customer inquiries using an effective consultative selling approach by asking appropriate questions and matching the right product to the customer’s needs, resulting in closed sales as well as increased customer satisfaction.
• Identified, investigated, and resolved customer complaints and concerns
• Perform claim adjustments to correct erroneous
payments(overpayments/underpayments)
• Manage and ensure appropriate follow-up and closure for all inquiries
• 3M Group Pricing
• Participate in Special Projects involving claims status investigation CUSTOMER SERVICE REPRESENTATIVE
JULY 2014 – MAY2016METROPLUS HEALTH PLAN NEW YORK, NY
• Provided comprehensive customer service to members, providers, and prospective members.
• Documented all customer contacts into tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientation, claims review inquiries, and handle provider inquiries
• Responded to all billing and claim inquiries from providers and members
• Provided on-site as well as telephone orientation to new and existing members.
• Provided all benefit service related information to members and providers
• Updated all members demographic changes
• Listened attentively to caller needs to ensure a positive customer experience
LICENSE MEDICARE ADVANTAGE SALES AGENT/CUSTOMER SPECIALIST AUGUST 2011 – JULY 2014
AEGIS COMMUNICATIONS NEW YORK, NY
• Responded to inbound customer inquiries using an effective consultative selling approach by asking appropriate questions and matching the right product to the customer’s needs, resulting in closed sales as well as increased customer satisfaction.
• Identified, investigated, and resolved customer complaints and concerns
• Perform claim adjustments to correct erroneous
payments(overpayments/underpayments)
• Manage and ensure appropriate follow-up and closure for all inquiries
• 3M Group Pricing
• Participate in Special Projects involving claims status investigation CUSTOMER SERVICE REPRESENTATIVE
JULY 2014 – MAY2016METROPLUS HEALTH PLAN NEW YORK, NY
• Provided comprehensive customer service to members, providers, and prospective members.
• Documented all customer contacts into tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientation, claims review inquiries, and handle provider inquiries
• Responded to all billing and claim inquiries from providers and members
• Provided on-site as well as telephone orientation to new and existing members.
• Provided all benefit service related information to members and providers
• Updated all members demographic changes
• Listened attentively to caller needs to ensure a positive customer experience
LICENSE MEDICARE ADVANTAGE SALES AGENT/CUSTOMER SPECIALIST AUGUST 2011 – JULY 2014
AEGIS COMMUNICATIONS NEW YORK, NY
• Responded to inbound customer inquiries using an effective consultative selling approach by asking appropriate questions and matching the right product to the customer’s needs, resulting in closed sales as well as increased customer satisfaction.
• Identified, investigated, and resolved customer complaints and concerns
concerns
• Enrolled prospective and current members into Health Medicare Advantage and Prescription Drug Plans.
• Processed payment in ebilling and OHBP portal
• Performed data entry into automated programs to track applications or other pertinent data, depending on assignment
• Performed administrative tasks, such as maintaining records and handling policy renewals;
COMMUNITY SERVICE AIDE
JANUARY2003-FEBRUARY 2011
NEW YORK CITY HOUSING AUTHORITY BROOKLYN, NY
• Planned, implemented and documented successful educational, recreational, youth leadership, community service and arts activities with school-aged children
• Performed community work and services with school-age children/teenagers.
• Assisted in enrollment, recording and submitting daily attendance records, and any other required documents to Director;
• Performed general office duties such as data-entry, managing phone lines, and sorted mail.
CLERICAL ASSISTANT/TEMP
MARCH 2000-SEPTEMBER 2002
NEW YORK CITY HOUSING AUTHORITY NEW YORK, NY
• Directed calls to the appropriate staff members and transcribed accurate messages when staffers are unavailable
• Maintained office supplies by replenishing stock and stationery ordering for the department
• Handled processing of applicants information in the Human Resources database.
concerns
• Enrolled prospective and current members into Health Medicare Advantage and Prescription Drug Plans.
• Processed payment in ebilling and OHBP portal
• Performed data entry into automated programs to track applications or other pertinent data, depending on assignment
• Performed administrative tasks, such as maintaining records and handling policy renewals;
COMMUNITY SERVICE AIDE
JANUARY2003-FEBRUARY 2011
NEW YORK CITY HOUSING AUTHORITY BROOKLYN, NY
• Planned, implemented and documented successful educational, recreational, youth leadership, community service and arts activities with school-aged children
• Performed community work and services with school-age children/teenagers.
• Assisted in enrollment, recording and submitting daily attendance records, and any other required documents to Director;
• Performed general office duties such as data-entry, managing phone lines, and sorted mail.
CLERICAL ASSISTANT/TEMP
MARCH 2000-SEPTEMBER 2002
NEW YORK CITY HOUSING AUTHORITY NEW YORK, NY
• Directed calls to the appropriate staff members and transcribed accurate messages when staffers are unavailable
• Maintained office supplies by replenishing stock and stationery ordering for the department
• Handled processing of applicants information in the Human Resources database.
concerns
• Enrolled prospective and current members into Health Medicare Advantage and Prescription Drug Plans.
• Processed payment in ebilling and OHBP portal
• Performed data entry into automated programs to track applications or other pertinent data, depending on assignment
• Performed administrative tasks, such as maintaining records and handling policy renewals;
COMMUNITY SERVICE AIDE
JANUARY2003-FEBRUARY 2011
NEW YORK CITY HOUSING AUTHORITY BROOKLYN, NY
• Planned, implemented and documented successful educational, recreational, youth leadership, community service and arts activities with school-aged children
• Performed community work and services with school-age children/teenagers.
• Assisted in enrollment, recording and submitting daily attendance records, and any other required documents to Director;
• Performed general office duties such as data-entry, managing phone lines, and sorted mail.
CLERICAL ASSISTANT/TEMP
MARCH 2000-SEPTEMBER 2002
NEW YORK CITY HOUSING AUTHORITY NEW YORK, NY
• Directed calls to the appropriate staff members and transcribed accurate messages when staffers are unavailable
• Maintained office supplies by replenishing stock and stationery ordering for the department
• Handled processing of applicants information in the Human Resources database.
concerns
• Enrolled prospective and current members into Health Medicare Advantage and Prescription Drug Plans.
• Processed payment in ebilling and OHBP portal
• Performed data entry into automated programs to track applications or other pertinent data, depending on assignment
• Performed administrative tasks, such as maintaining records and handling policy renewals;
COMMUNITY SERVICE AIDE
JANUARY2003-FEBRUARY 2011
NEW YORK CITY HOUSING AUTHORITY BROOKLYN, NY
• Planned, implemented and documented successful educational, recreational, youth leadership, community service and arts activities with school-aged children
• Performed community work and services with school-age children/teenagers.
• Assisted in enrollment, recording and submitting daily attendance records, and any other required documents to Director;
• Performed general office duties such as data-entry, managing phone lines, and sorted mail.
CLERICAL ASSISTANT/TEMP
MARCH 2000-SEPTEMBER 2002
NEW YORK CITY HOUSING AUTHORITY NEW YORK, NY
• Directed calls to the appropriate staff members and transcribed accurate messages when staffers are unavailable
• Maintained office supplies by replenishing stock and stationery ordering for the department
• Handled processing of applicants information in the Human Resources database.
Contact this candidate