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Customer Service Representative

Rego Park, New York, United States
December 03, 2017

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Mark Balacic

**-** ******** *****, ********, NY *1385

646-***-**** •

Qualifications Summary

Seasoned customer service professional with almost 17 years of comprehensive working experience in dispensing customer service functions in the healthcare industry.

Proven capacity in efficiently managing accounts and addressing customer concerns.

Possess strong communication skills in conveying complex information to customers in user friendly terms, and in providing vital medical and insurance information.

Capable of carrying out duties pertinent to maintaining an acceptable quality of service in accordance with established standards and corporate goals.

Demonstrate strong work ethic and versatility in accomplishing multiple tasks efficiently and in resolving issues related to healthcare transactions.

Educational Background

Bachelor of Business Administration – Major in Marketing, 1992

Hofstra University – Hempstead, NY

Professional Experience

Emblem Health, New York City, NY

Customer Service Representative – Medicare Benefits Coordination and Recovery Center 2004 2016

Responsible for delivering accurate and timely updates to various Center for Medicare and Medicaid database systems while maintaining a comprehensive insurance file according to Medicare Secondary Payer and Recovery Regulations.

Key Achievements:

Commended for consistent efficiency in resolving and completing customer requests through intensive examination and review of incoming Medicare beneficiary, medical provider, attorney, and insurance carrier inquiries in coordination with other departments.

Successfully reduced inaccurate Medicare payments by ensuring the proper subrogation and application of Center for Medicare and Medicaid Services guidelines for Workers Compensation, Liability, No Fault, and Group Health coverages.

Instrumental in improving accuracy of data management by providing assistance to the Data Match Project which validated and certified insurance information obtained for employees and eligible family dependents.

Recognized for outstanding work in resolving all customer concerns and educating callers on the Medicare Secondary Payer program while following all internal security procedures to ensure compliance with HIPPA federal privacy laws.

Played a key role in ensuring proper management of information by assisting in the review of new database systems for the department.

Customer Service Representative – Subscriber Relations 1999 2004

Enrolled and updated new and existing members into Emblem Health plans. Coordinated with Benefits Administrators to establish employees in health insurance plans.

Key Achievements:

Aided in improving operations of account management by collaborating with supervisors to recommend and implement changes for enhancing the resolution process of subscriber complaints and account errors.

Successfully conducted training programs on establishing and maintaining subscriber relations for new employees.

J&R Music World, New York City, NY 1994 – 1999


Provided management oversight to a staff of 20 personnel and conducted internal and external administrative follow-up.

Key Achievements:

Delivered key contributions to assist in the professional development of Customer Service Representatives by conducting pertinent training programs.

Ensured adherence to critical guidelines and achievement of organizational objectives by delegating duties and monitoring performance of all Customer Service personnel.

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