Customer Service Medical

GENICE BOBB

***** ********* ****** *****, **********, MD 20613 C: 407-***-**** **********@*******.***

Skilled and knowledgeable Benefits Specialist in the healthcare industry with 10+ experience in government programs, insurance, and client relations. Expertise in training, interviewing, and hiring process. Consistently advocating on behalf of members and creating a satisfying experience.

Carefirst BCBS – Washington, DC August 2003 – December 2017

Utilization Review Specialist III

Created positive outcomes for client's denied claims.

Effectively managed dept. team as an appeals expert for a high-volume of inbound and outbound customer calls.

Accurately documented, researched and resolved customer service issues.

Mastery of customer service management systems and databases.

Referred unresolved customer grievances to designated departments for further investigation.

Prepared reports and cases for medical review by senior nurse management and medical director.

Evaluated all evidence with the ultimate goal of timely filing.

Appropriately identified and referred cases that did not meet established clinical criteria to the Medical Director with appropriate detail and documentation provided for a decision to be rendered.

Collaborated with hospital case managers, social workers and other facilities staff as needed to facilitate discharge and coordinate services.

Trailblazer Health Enterprises, Huntvalley, MD June 2001 – August 2003

Fep Provider Service Rep III

Provided exceptional customer service by supporting Claims team and responding to inquiries from FEP providers.

Answered provider inquiries regarding verification of benefits and Claims status for medical and dental claims.

Provided a variety of other duties and projects assigned by Management to support the company.

Entered precertifications into the claims processing system, worked miscellaneous claims queues, sent out correspondence, outbound provider call projects, and reviewed claims spreadsheets and plan documents.

Trailblazer Health Enterprises – Huntvalley, MD January 2000 – June 2001

Medicare Service Rep I &II

Communicated with Medicare patients and referral sources both verbally and in writing to ensure patient questions and concerns were processed in a timely manner.

Coordinated all patient information, processed paperwork, completed batch reports with all applicable company policies and procedures to meet Medicare enrollment standards.

Gathered and verified all required customer information for tracking purposes.

Addressed and resolved customer product complaints empathetically and professionally.

Education & Certifications

MBA: Executive Business Mgmt

Colorado Technical University – Colorado Springs, CO

2010

AAS: Liberal Arts

Kingsborough Community College – NY

2000

BA: Business Administration, 2007

Morgan State University - Baltimore, MD

2007

Awarded Volunteer certificate for 2 years serving as PGCPS Policy Council secretary.

PGCPS Head Start Policy Council Member - 2014 to 2016

PGCPS PTA Secretary / Event Volunteer - 2016 to present

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