Customer Service Representative

John C. Michener Medical Claims Specialist

********@*******.*** 215-***-**** (H) 267-***-**** (C) Philadelphia, PA 19131

Tenured and accomplished Medical Claims Specialist, with a reputation for achieving consistent results, ensuring the highest level of compliance and quality control for claims processing. Intuitive leader with the ability to educate and motivate team members, proactively identifying opportunities to reduce errors and increase productivity to meet or surpass organizational goals.

Areas of Expertise include:

Insurance Claim Filing/Processing

Account Management

Customer Service

Regulatory Compliance

Patient & Provider Liaison

Training & Mentoring

AR Reporting

Auditing/Quality Assurance

Records Management

Professional Experience

Amerihealth Caritas• Philadelphia, PA (Please provide location of this employer.) • May 2012 to March 2017

Team Lead

Led a team of claims processors for Select Health of South Carolina, responsible for processing Medicaid claims

Key Accomplishments:

Reduced errors and mitigated potential issues with claims and processing, ensuring compliance with company policies and regulatory requirements.

Assumed additional claims projects and assisted management team with reporting.

Conducted thorough audits on claims with appeals requested by examiners, and provided feedback to resolve any issues to successfully process the claim.

Mentored team of claims examiners, serving as a resource for any questions and facilitating additional training as needed.

Stratmar Financial and Retail • Philadelphia, PA • February 2012 to May 2012

Marketing Rep

Engaged customers within the Philadelphia International Airport and identified opportunities to educate the customer and promote the benefits of the Chase Southwest Airlines Visa Card.

Key Accomplishments:

Employed best practices to close on new accounts and consistently meet or surpass individual sales metrics.

Resolved any questions or concerns posed by customers to optimize sales experience and overall satisfaction.

Farmers and Erie Insurance • King of Prussia, PA • February 2009 to November 2011

Insurance Agent

Key Accomplishments:

Prospected new clients, set appointments, and followed-up to close new accounts and meet or exceed established benchmarks for life, property, and casualty insurance sales.

Communicated regularly with new and existing clients to meet any servicing needs in the interest of customer retention and repeat business.

RecordTrak • King of Prussia, PA • November 2007 to November 2008

Customer Service Rep

Interacted with record custodians to process records requests and expedite record production in alignment with customer needs, in an inbound/outbound call setting.

Key Accomplishments:

Collect medical, personnel, educational, and employment records as needed, via phone and fax.

Evaluated records for completeness and accuracy, and to ensure compliance with HIPAA and other regulatory requirements.

Previously employed as a Provider Service Representative for Aetna Inc/Prudential Healthcare from 1991 to 2006, and as a Customer Service Supervisor for Prudential Healthcare from 1988 to 1991.

Education

Diploma,

William Tennent Senior High • Warminster, PA

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