Customer Service Administrative Assistant
Resume:
Susan Tomlinson
New Haven, CT 06511
Phone 203-***-****
ac52l4@r.postjobfree.com
Summary
Customer Service professional responsible for resolving difficult and escalated calls known as the “Super Queue" within call center environment. I have been acknowledged for establishing good rapport with customers and have achieved success because I don’t let the customer get overwhelmed and keep them calm. Recognized as a “top performer” in customer service according to management and customers. . Rewarded with customer letters and gifts for results I deliver. Whether it’s over the phone or in person my customers are satisfied.
Professional Experience
Kelly Services - Anthem Wallingford, CT 2017-
Customer Care Representative
● Respond to Medicare Supplement Members and Providers with answers to their questions on their policy, eligibility, benefits, claims, premiums, website
● Effectively provide resolution to challenging service issues in a timely
manner.
Operate and monitor multi-systems to take care of members.
● Fax & mail documents to customers
● Efficient and resourceful insurance advocate for customers seeking answers. I am empathetic advocate and I try to assist the member the best I can to make calling Anthem a positive experience
UnitedHealthcare 2012-2016
Clinical Administrative Coordinator
● Effectively provide resolution to challenging service issues in a timely manner keeping the customer first. Knowledge & Interpretation of HCPC & ICD-10 codes assisting & resolving issues with prior authorization for members and providers
l Contacted member and provider for diagnostic and procedure coding info
l Loaded clinicals into system & approve if meets medicare criteria
l Submitted to medical director or nurse for further review
l Interacted with other departments as needed Document and follow UHC protocol
l Notified member and provider of decision and appeal rights if needed
Susan Tomlinson
HealthNet of the Northeast 2003-2010
Customer Service Rep II
l Efficient and resourceful insurance advocate for customers seeking answers
l Effectively provide resolution to challenging service issues in a timely manner
l Knowledge & Interpretation of HCPC & ICD-9 Codes assisting & resolving issues with claims for members and providers
l Manage incoming calls thru ACD system, Documenting all calls, lobby visits & correspondence for the following:
Medicare & Medicaid proficient effectively communicate benefits info, Explained how to Appeal &Grievance, Research their authorizations, Explain their
Medicare D cost, Advise LIS info & how to apply, Assist with finding a provider, Enrollment issues, Explained EOB, Interact with other staff to get issue resolved, Resolve CTM complaints
Register members on HealthNet website & teach them how it works
Assist Sales Department at Retention Seminars Worked closely with them to resolve member issues for prospective and enrolled
Assisted with Management & Marketing with designing TakeCare program for our Seniors
Resource & Mentor For Medicare Representatives Also assisted with training of new hire
Assist Management & Peers with escalated issues & getting them resolved
Knowledgeable with PPO policies, Medicare Broker Line and Provider line (commercial members, individual members)
AMHEALTHGROUP/ COLLINS I.V. CARE, INC. 2000-2002
Enteral Coordinator
Customer Service Associate to over 400 patients per month
l Responsible for intake, order processing, insurance verification, certification and authorization
l Coordinated home deliveries, and nursing schedules
Performed home visits teach proper use and care of Enteral Pump
l Maintained inventory for supplies and responsible for orders and deliveries
Administrative Assistant
l Maintained patient records, active/ discharged/ archivedCharts
l Responsible for the filing of all medical and financial documentation
l Oversight of physician files
l Track and obtain patient A.O.B. (assignment of Benefits)
Susan Tomlinson
Education
Housatonic Community College 1974
Certified- Office Communication Skills
Computer Skills
MS Office, IBM Systems, ACD, Aspect, Cisco, Lotus Notes, Outlook, MBI system, HCPC & ICD-10 coding, HIPPA Compliant, Avaya phone, Lync, ACI, Marxx
Contact this candidate