San Angelo, TX *****
email@example.com - 325-***-****
Accomplished and energetic Quality Auditor of Customer Service with a solid history of achievement in insurance claims. Motivated leader with strong organizational and prioritization abilities. Areas of expertise include medical insurance claims, customer service and compliance.
Authorized to work in the US for any employer
Mary Kay Consultant/Insurance Agent
San Angelo, TX - August 2003 to Present
Complete forms in accordance with company procedures. Attend meetings, seminars and programs to learn about new products and services, learn new skills, and receive technical assistance in developing new
Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
Seek out new clients and develop clientele by networking to find new customers and generate lists of prospective clients.
Confer with customers by telephone or in person to provide information about products and services, enroll or cancel accounts and to resolve customer's
problems or concerns.
Explain features, advantages and disadvantages of various policies to promote sale of insurance plans.
Customer Service Representative
AT&T - San Angelo, TX - June 2014 to December 2014 Confer with customers by telephone to provide information about products or services, billing, or obtain details of complaints.
Kept records of customer interactions, transactions, details of inquiries, complaints, and comments, as well as actions taken.
Check to ensure that appropriate changes were made to resolve customers' problems.
Refer unresolved customer grievances to designated departments for further investigation.
RAC Customer Service Specialist II
Diversified Collection Services - June 2009 to August 2010 Responded to providers that were a part of the Federal Government/Centers for Medicare and Medicaid by phone, mail, fax and email. Analyzed data to identify improper payments made on claims provided to Medicare beneficiaries and educated the providers on these issues. Involved in the development of the department procedures and the Quality Assurance Program.
Operate electronic mail systems and coordinate the flow of information, internally or with other organizations. Quality Assurance Auditor, Technician, CSR, Claims Processor Blue Cross Blue Shield - May 1998 to February 2008 Conducted phone and written inquiry audits to identify and analyze discrepancies for call center. Point of contact for high priority groups including educating group on benefits, performing site visits, testing claims in processing system and providing customer service to resolve any and all issues.
Processed member/provider medical insurance claims, performed adjustments/recoupments, resolved hold codes.
Prepare detailed reports on audit findings.
Report to management about asset utilization and audit results, and recommend changes in operations and financial activities.
Conduct pre-implementation audits to determine if systems and programs under development will work as planned.
Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken. EDUCATION
Associate in Applied Science Health Information Technology Howard College
Medical Terminology (10+ years), Insurance (10+ years), Customer Service Skills (10+ years), Sales (5 years), Quality Assurance (8 years), Claims Processing (10+ years), Hipaa (10+ years), Call Center (10+ years), Medical Records (10+ years), Medicare (10+ years) ADDITIONAL INFORMATION
Quality Control Analysis Active Listening
Production and Processing Judgment and Decision Making Complex Problem Solving Customer and Personal Service HIPAA compliant