Resume

Sign in

Customer Service Manager

Location:
Washington, District of Columbia, United States
Salary:
93,000
Posted:
November 27, 2018

Contact this candidate

Resume:

OBJECTIVE:

To land a managerial position utilizing my marketing/business management skills with a viable company or department in a leadership capacity where professionalism, and a track record for quality are valued & required for attaining career growth

EDUCATION:

Howard University- Location Washington, DC Graduation: May 2011

BA: Marketing

WORK EXPERIENCE:

August 2016-

Present Corvel Corporation Contract, Largo MD, Prince Georges County

TPA Claims Adjuster

Receives claim, confirms policy coverage & acknowledgement of claim

Determines validity & compensability of claim by investigating and gathering information file necessary documentation with state agencies

Develop and manage well documented action plan with case manager, attorney, supervisor and client to reduce overall cost of claim

Coordinate early return to work efforts with case manager and employer

Negotiate settlements when necessary

Actively manage litigation process

Identifies potential subrogation claims

Communicate claim status with customer and claimant

Review and update client on risk factors that can be avoided and lower future cost

June 2015-

August 2016 Excalibur Legal Staffing, Office of Risk Management, Washington, DC

TPA Claims Adjuster Corvel Contract

Obtained relevant medical records and statements from the treating physician.

Contact the insured to verify and complete the claim report, and obtains information necessary to properly act upon the claim. Contacted the claimant for description of injury and other pertinent information, and maintains appropriate written records of statements and facts relating to the claims.

Accepts or denies payment of assigned claims within the requirements of the Workers' Compensation Act, and make referrals to outside field investigators for further review including activity checks and surveillance.

Actively manage the litigation process as well as manage potential claim recoveries of all types

Communicate claim status with the customer and claimant,

Adhere to client and TPA guidelines and participate in claims review as needed

Develop and maintains professional customer relationship

August 2014- Univita Health- Miramar, FL

June 2015 TPA Claims Examiner

Responsible for accurate and timely filing adjudication of claims according to state and federal regulations Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits

Process both professional (CMS 1500) and institutional (UB-04) claim types

Reconciliation of historical paid data and provider A/R5. Maintain quality and productivity standards as set by management

Knowledge of HIPAA Privacy Rules

Resolve provider network claims inquiries and apply resolution in a timely fashion

Audits claims entry process for quality assurance

October 2013-

June 2014 FIM- First Insurance Management, Office of Risk Management, Washington, DC

TPA Claims Adjuster Corvel Contract

Contact the insured to verify and complete the claim report, and obtains information necessary to properly act upon the claim. Contacted the claimant for description of injury and other pertinent information, and maintains appropriate written records of statements and facts relating to the claims.

Obtained relevant medical records and statements from the treating physician.

Accepts or denies payment of assigned claims within the requirements of the Workers' Compensation Act, and make referrals to outside field investigators for further review including activity checks and surveillance.

June 2012-

October 2013 IWIF- Injured Workers Insurance Fund, Towson, MD

Claims Adjuster, Trainee Program- 4 month rotation in 8 departments

Receive and review Workers Compensation claims and reports to determine if occupational illness or injury is compensable; develop documentation for claim reports by requesting substantiating reports from physicians, supervisors, and witnesses

Review injury reports for completeness and consistency; resolve discrepancies in data;

Compute and authorize payment or denies claims on a timely basis; refers questionable claims needing investigations to the Special Investigation Unit and settlement recommendation

March 2010-

April 2013 ACCRETIVE HEALTH, Providence Hospital Washington, DC

Operation Lead Supervisor / Financial Counselor/ Billing Specialist, Department: Scheduling/Admitting/Registration

Maintained and Ensured accurate billing services and billing reports

Collected all necessary patient documentation for claim submissions

Assisted with patient inquires concerning health insurance

Responsible for assisting with overall operation of the ER to increase continuous flow of revenue stream

Ensuring a high quality patient experience with the hospital’s business office; while accurately and efficiently gathering and verifying the complete demographic, financial, payer authorization and clinical data on assigned patients to ensure proper payment to the hospital.

Exceeded established department productivity goals 16% through development / implementation of best practices to increase employee output, communication of corporate objectives and introduction of compensation plans to reward high-performing individuals

Work with managers and directors to meet performance targets and initiatives; and Recommend operational improvements

July 2004- HOWARD UNIVERSITY TV STATION (WHUT) Washington, DC

May 2010 Intern/ Work Study Supervisor

Managed 50,000 commercial videos in the station to keep new videos updated

Developed good relationship with pledge participants which lead to top sells that year

Honored with the “Customers Come First” award for consistently resolving customer difficulties in an expedient and tactful manner

SKILLS

PRODUCTION: Television Production crew, Digital Media, Photography

Computer Skills: Meditech, AS400, HMED, Proficient in Microsoft Office (Microsoft Word, Access, Excel, Database, PowerPoint) Word Processing, FrontPage, Visual Basic, Flash

VOLUNTEER EXPERIENCE

2010-2013

Charmique Vogue Company Admin. Assistant: Assist the director with scheduling appointments, client follow-up phone calls, customer service, light typing, forms data entry, event planning assistance, etc.

2008- 2010

REID TEMPLE AME CHURCH: ANGELOS MINISTRY Youth Director: Provide comprehensive media services to support church events. With quality sound, lighting, and recording services for all worship services as well as for special events such as concerts and workshops or any other activity as requested by the ministries of Reid Temple AME Church.



Contact this candidate