Claims Representative - Tower Watson/One Exchange
Irving, TX 75062
Qualified Claims/Customer Service Representative able to investigate claims, verify information and facilitate a resolution. Result driven, friendly and upbeat team player with an organized and disciplined approach. Seeking a permanent role with company that values not only their customer but employee and promotes within.
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Tower Watson/One Exchange - Richardson, TX
August 2016 to Present
Actively listen and facilitate first call resolutions for Medicare eligible retirees to the highest level regarding any HRA account related issues, claim processing issues, and medical benefits Initiate telephone calls to the carrier or other departments to further facilitate a resolution Clearly convey with confidence a comprehensive understanding of the company services over to customers to assume ownership.
Respond to general technical issues and assist customers with setting up online accounts Review and analysis plan benefits and account information to recommend other products or services offered.
Examine supported documents to capture vital information needed to process claims Convey information needed to re-process adverse claim decisions resulting in denying claims Expedite claims processing for pending or denied claims Issue void/re-issues or stop payment on refunds where as check is know longer negotiable.
Member Service Representative
Dialog Direct/BCBS - Fort Worth, TX
March 2016 to August 2016
Assisted company with maximizing production by utilizing BIBS software and systems to respond to customer inquiries regarding their plan benefits
Processed daily invoices and billed renewed invoices to clients. Documented all customer inquiries and comments thoroughly and quickly. Processed cash and credit payments rapidly and accurately. Initiated 3-way phone calls to outside parties and other departments to further assist members Escalated incident tickets to the next level when unable to provide a resolution Processed new ID cards, insurance policies, endorsements, policy renewals and cancellations in a timely manner.
Clearly convey plan benefits and products with confidence and take ownership and suggest product change
Alcorn State University - Lorman, MS
September 2013 to January 2016
Implemented new electronic records management system that ensured swift and accurate information/ records retrieval and delivery service for the campus community Implemented policies and procedures to protect the privacy of personal information
Maintained and updated records through a dedicated digital database. Documented daily interaction via incoming and outgoing Assisted IT department with troubleshooting records database or any other technical issues.
Bachelor of Science in Criminal Justice
Grambling State University - - Grambling, LA
BUSINESS DEVELOPMENT, CLIENT RELATIONS, CREDIT CARD, DATA ANALYSIS, DOCUMENTATION, Call Center, Customer Service, claims examination & processing Additional Information
Documentation review Customer-oriented
Policy understanding Credit card processing
Results-oriented Quick learner
Business development Creative problem solver
MS Office Medical terminology knowledge
Analytical Multi-line phone talent
Data analysis MS Windows proficient
Proactive team player Strong client relations
Time management Exceptional communication skills
Personable strong interpersonal Computer literate