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Customer Service Medical

Garner, North Carolina, United States
May 31, 2018

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Linda C. Cooper

Home 919-***-****

Cell 919-***-****


Objective: To be a part of a company that is diverse in a global world class society.

Microsoft Outlook, Excel, PowerPoint, Microsoft Word, E-mail, Faxing, Copiers, Printers, Mail meters, Scanners, PeopleSoft, AS400, PeopleSafe, Medical Insurance, Medical Billing & Coding, Medical Terminology, Amisys, CRM, Macess, Verifide, SharePoint, Proview, CBAS, Medhok

Conduent/Aetna, Inc. 10/30/2017-February 2018

HCFSA Customer Service Agent

Providing member’s with eligible flexible spending account benefit information

Educating member’s concerning there eligibility amounts and terms of account

Assisting member’s with enrollment election period duration and term

Providing member’s with how their flexible spending works during eligibility period

Educating member’s concerning the Roll Over period and Grace period duration

HCL America, Inc. 4/24/2017-7/25/2017

Provider Credentialing Analyst

Providing credentialing verification of doctors and other healthcare practitioners

Reviewed the provider’s completed training, education, any certifications, etc.

Reached out to provider’s or credentialing contact to ensure provider files were current

Compile, analyze, and verify the required information for provider enrollment, contracts, and maintenance for completeness and accuracy and enter it into the systems of record

Excel spreadsheet used daily for work order tracking of all files

Human Solutions Group Dec 2016-April 02, 2017

Body Scanner Operator

Scanning human participants for size measurements

Conducting surveys on humans for better sizing

This survey was conducted to get an accurate fit for clothing manufactures and product


More accurate data on body sizes and shapes using a 3D scanner, etc.

Blue Cross Blue Shield NC Dec 2015-May 06, 2016

Pharmacy Services Coordinator

Approving Prior Authorizations request for Medicare/Medicaid Part D Members

Working in CMM/Utilization Management/HIPPA adherence

Data entry of Authorizations using excel spreadsheets

Provide support to Corporate Pharmacist/Medical Directors/Clinical Operations

Decision diagnosis compatibility per drug request

Xerox Nov 2013-Aug-2015

Coverage Determination and Appeals Professional

Inbound/Outbound calls/Providers, Patients, Members, etc.

Assist pharmacist with applying clinical rationale

Assisting with denials not approvable meeting prudent criteria

Provide Appeals information on medical claims determination for coverage diagnosis versus medication request


TrialCard/Pharmaceutical Jan 2012-Sept 2013

Call Center Service Center Representative

Inbound/Outbound calls

Serviced patient’s and pharmacist

Activated Co-pay cards

Provided technical support to pharmacist for card processing

Informed caller concerning drug side effects, etc.

Wells Fargo Sept 2011-Dec-2011

Human Resource Specialist/HRSC

PeopleSoft navigation

TCRM (time keeping system) Sharepoint/Policies and Guidelines

Servicing team members Annual benefit enrollment 2012

Answering team member benefits questions

Enrolling Team Members in benefits

Servicing Team Member with an Excellent Customer Experience

Imperial A.I Credit, Eastern Service Center Mar 2007-Mar 2011

Call Center Customer Service Representative

Handling Inbound service calls

Processing NOC’s REI, NOA’s

Assisting clients with insurance billing/payments

Documenting calls in tracking system

Quintiles, Inc., Morrisville, NC Jun 2006- Dec 2006

Site Coordinator

Tracked provider accounts using Inntrax database system

Tracked provider accounts using (Qsims) data management system

Tracked provider information on clinical trials/clinical research

Recruited new PA’s for clinical research studies

Contact event tracking, etc.

Southeastern Claims Services, Inc. Nov 2005-May 2006

Claims Examiner

Handled medical only claims

Handled calls concerning status on a claim

Mailed out request forms for medical records or UB92’s/HICF

Typed various medical forms pertaining to NCIC statistic

Paid medical bills to various providers A/R A/P

Mailed EOB’s to medical providers

Cigna Healthcare Aug 2003-Jan 2004

Customer Service Representative

Assisted Healthcare Nurses

Made outbound calls to area Hospitals

Requested discharge dates

Faxed medical records to hospitals

Filed medical records

Coverall of Raleigh/Durham Feb 2000-Sept 2001

Administrative Assistant

Typed proposals for outside sales department

Filed, ordered supplies for office as needed

Made appointments for perspective franchise owners

Distribution of mail incoming and outgoing

Directed inbound and outbound calls for entire office

Calendar Maintenance, maintained a database for new customer accounts


Wake Technical Community College Received 2011

Medical Office Specialist, Certificate

AAPC member

Wake Technical Community College Received 2009

ICD-9-CM, CPT Coding


Phillips Junior College of Business Received 1991

Associate of Applied Science Degree Word Processing

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