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Customer Service Care

Location:
Raleigh, North Carolina, United States
Posted:
November 08, 2018

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Resume:

DARLENE EVANS

Objective:

I am seeking to obtain a full-time position with career growth potential that will allow me to utilize and enhance my current skills while developing more skills. With the expectations of new heights and growth. I bring with me my several years of experiences and various skills into a new era of my career life.

WORK EXPERIENCE

BENEFIT SPECIALIST / TRAINER

Affordable Care and Implants - Morrisville, NC

January 2018 – July 2018

Provide training via webinar on the various dental insurance plans to the dental practice staff members

in over 240 locations nationwide.

Respond to inquiries via emails, skype and/or incoming calls from external and internal clients regarding

various claims issues, web portal passwords, fee schedules, scheduling trainings, and more.

Updating billing entities and accounts, ePrescribing enrollments, resetting web portal and

applications passwords.

Troubleshoot various problems with the dental claims processing system, Dentrix.

Document calls and email responses into the SalesForce application.

INSURANCE BILLING SPECIALIST

PFS Group - Cary, NC (Contract)

May 15, 2017-August 14, 2017

Provided regular daily communication with insurance companies to ensure timely resolution of account balances and patient’s eligibility for date of service

Placed outbound calls and received incoming calls to facilitate collection and resolution of insurance accounts

CLAIMS SPECIALIST

IBM Seterus – Durham, NC

April 4,2016-March 31,2017 (Contract)

Reconciliation of mortgage claims in foreclosure and bankruptcy

Researched and sorted through various documents by utilizing multiple resources such as Safeguard, SCI, Lereta, QBE, Loansphere, MSP, Home Tracker and NETR to locate and pull all necessary documents usable to obtaining reimbursement from FNMA of services paid to maintain and preserve real estate properties

Troubleshot the root cause of curtailed claim items and resubmitted claim with supporting documentations to promptly collect payments on services previously provided

SENIOR CUSTOMER CARE REPRESENTATIVE/RECEPTIONIST

MVP Health Care – Rochester, NY

April 1997-July 2015 (Senior Customer Care Representative)

November 1995-April 1997 (Receptionist)

Responded to customer inquiries in areas of enrollment, premium billing/payments, claims, benefit interpretation, and referrals/authorizations for medical care and prescription (Rx) services

Provided support to other CSRs and the handling of escalated issues (calls)

Operated within the Macess, Facets and AMISYS claims processing systems

Performed service issue research and resolution, reporting, special projects, etc.

Comprehended and serviced a variety of insurance types including HMO, POS, EPO, PPO, ASO, Indemnity, Medicare and Medicaid

Received and logged all forms of premium payments

Answered phones and greeted clients

Performed miscellaneous office duties including filing.

SKILLS

Proficient with Microsoft Word and Outlook

Intermediate level of Excel

Strong PC skills using Windows applications

Excellent oral/written communication and effective interpersonal skills

Trouble shooting/problem solving skills

People person

Strong organizational skills

Comprehension of HIPAA regulations and compliances

Steadfast to providing excellent customer service and process improvement

Able to maintain self-control in the face of hostility and function effectively under pressure

Type approximately 60 wpm

Medical terminology

Critical thinking / resourceful

Mentor/Trainer



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