Customer Service Insurance
Resume:
MALCOLM SAXTON
**** ****** ** *********, ***** CAROLINA, 28269 704-***-**** ***********@*****.***
WORK EXPERIENCE
Randstad (Ft Mill, SC)
Patient care coordinator
A Patient care coordinator main function is to insure a patient can receive their medication an doctor office procedures at a price rate they could afford as well as coordinating with doctors office to clarify which services would be covered for if rendered.
As a secondary function, I also assisted the patient with securing other ways of obtaining their medication an assisting pharmacy with processing medical claims through are company at no cost to the patient if approved.
Finally as patient care coordinator it was my duty to insure all claims issues processed through are company had to be cleared up with PDMI (Pharmacy Data Management Inc)
AmerisourceBergen (Charlotte, NC)
Sr. Reimbursement Counselor- Site coordinator (4/25/2016 – 8/1/2017)
As a Reimbursement counselor, it was my duty to document new payer (insurance company's) Trends I.E Change in name, Phone numbers, and Claims address's. As well as completed high level benefit investigations for doctors’ offices.
identify third party prior authorization Depts., note specialty pharmacy phone numbers names and claims address's as well as determine any special instructions for covered codes and administration so that claims were processed correctly and on time.
It was my responsibility to review peer summery of benefits to insure accuracy for are providers as well properly communicate concerns from are providers to management if the problem was not in my scope of abilities to manage it was then also my responsibility to assure the investigation was completed correctly to ensure that claims were processed correctly and on time.
Talent Bridge Staffing (Charlotte, NC)
Reimbursement counselor- Site coordinator (11/11/ 2015 – 4/25/ 2016)
It was my responsibility to obtain benefits from payer on behalf of providers utilizing ICD-10 coding, three different access options and obtain specialty pharmacy information
Gathering Prior authorizations and or pre-determination requirements for different ICD-10 and admin codes and services.
Upon proving myself as competent benefit investigation specialist I was promoted to a Quality analyst were in my main duties was to review faxed E.O.B’s were sent correctly as well as communicating feedback from provider(s) to management to ensure that claims were processed correctly and on time. and still completing higher lever benefit investigation. At the end of the project I was awarded the top performer of the project.
ALLSTATE BUSINESS INSURANCE, CHARLOTTE, NC
Senior service agent, 7/7/ 2014 – 4/20/2015
I as a senior service expert was responsible for not only updating an maintaining existing policies it was also my duties to recommend additional converges that may be needed as well as business insurance expert I was responsible for assisting any allstate agent in the field who had questions concerning business insurance and or business insurance policies
Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
Check to ensure that appropriate changes were made to resolve customers' problems.
Determine charges for services requested, collect deposits or payments, or arrange for billing.
Review insurance policy terms to determine whether a particular loss is covered by insurance.
to ensure that claims were processed correctly and on time.
UNITED HEALTH CARE, CHARLOTTE, NC
group Medicare specialist, Jan 2013 – Dec 2013
Call on policyholders to deliver and explain policy, to analyze insurance program and suggest additions or changes, or to change beneficiaries.
Ensure that policy requirements are fulfilled, including any necessary medical examinations and the completion of appropriate forms.
Explain features, advantages and disadvantages of various policies to promote sale of insurance plans.
Customize insurance programs to suit individual customers, often covering a variety of risks.
As a group specialist I was trained to handle numerous specific pol with details that differed from the normal Medicare insurance provided as well know the difference between the different lines of insurance offered by each group
ADT SECURE WATCH, CHARLOTTE/TUCSON,AZ, NC
salesman,coach, trainer, Apr 2009 – Jan 2013
Confer with potential customers regarding equipment needs and advise customers on types of equipment to purchase.
Resolve customer complaints regarding sales and service.
Monitor, evaluate, or record training activities or program effectiveness.
Develop alternative training methods if expected improvements are not seen.
Answer customers' questions about products, prices, availability, product uses, and credit terms.
Recommend products to customers, based on customers' needs and interests.
Estimate or quote prices, credit or contract terms, warranties, and delivery dates.
Arrange and direct delivery and installation of products and equipment.
Negotiate details of contracts and payments, and prepare sales contracts and order forms.
Direct and supervise employees engaged in sales, inventory-taking, reconciling cash receipts, or in performing services for customers.
Instruct staff on how to handle difficult and complicated sales.
Establish and implement policies, goals, objectives, and procedures for their department.
FOODLION, CHARLOTTE, NC
cashier,customer service, Sep 2008 – Apr 2010
Assist customers by providing information and resolving their complaints.
Issue receipts, refunds, credits, or change due to customers.
Receive payment by cash, check, credit cards, vouchers, or automatic debits.
Greet customers entering establishments.
Establish or identify prices of goods, services or admission, and tabulate bills using calculators, cash registers, or optical price scanners.
Process merchandise returns and exchanges.
Maintain clean and orderly checkout areas and complete other general cleaning duties, such as mopping floors and emptying trash cans.
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EDUCATION
CPCC, CHARLOTTE, NC
ADDITIONAL SKILLS
>Currently hold life insurance license in North Carolina. >HEALTH, PROPERTY AND CASULTY LICENCE held in ALL 50 states.>Business insurance certified. >Medicare group specialist certified. >Long term care certified.
>Soft skills and consultative sales trainer.
Business insurance subject matter expert
Reimbursement subject matter expert
ICD-10 Coding experience
Credentialed Benefit investigation specialist
Contact this candidate