Customer Service Insurance
Resume:
Shakeyla Townsend
Charlotte, NC 28215
Cell: 704-***-****
Email: ********@*****.***
QUALIFICATIONS:
Ability to function proficiently with little supervision
Ability to prioritize and remain focused on multiple of an issues
Excellent customer services ability with focus on “First Call Resolution”
Skilled at learning new concepts quickly while working well under pressure
EXPERIENCE:
03/16- Present Lash Group (AmeriSourcebergen) Fort Mill, SC
Benefit Verification Specialist
Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payers. Researches and resolves any electronic claim denials.
Researches and resolves any claim denials or underpayment of claims.
Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
Processes any necessary insurance/patient correspondence.
Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation.
Communicates effectively to payers and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
Typically receives little instruction on day-to-day work, general instructions on new assignments.
Performs related duties as assigned.
11/13- 10/15 Blue Cross and Blue Shield Charlotte, NC
Customer Service Professional/ PRT Trainer
Teach CSPs about Insurance Claims (the process and denials)
knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding
Global understanding of commercial plans.
Ability to proficiently use Microsoft Excel, Outlook and Word
Educate CSPs on how to handle claim call and the research process
Answering Incoming Calls for Members and Providers regarding a variety of insurance coverage questions
Communicating responses to questions pertaining to Benefits, Eligibility and Claims.
Sending of customer communications via email, fax and letters.
Ability to report and correct minor system issues
Communicate with internal forecasting and scheduling center based on staffing
Call Quality Monitoring
Assist in Team Leader duties such as staffing directions and reporting system outages
Additional Positions upon request
EDUCATION:
East Mecklenburg High School, NC
Diploma, College Prep, 2006
University of Phoenix, Charlotte NC
Business Administration 2010- 2011
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