Customer Service Representative

Professional Summary

Skills

Work History

D F

**** ******** ***, **********, ** • 513-***-**** • *************@*****.*** Dedicated Customer Service Professional motivated to maintain customer satisfaction and contribute to company success. Excels at uncovering customer needs, finding solutions and handling objections. Reliable and driven with strong time management skills. Top performer with a consistent track record of meeting and exceeding goals. Excellent communicator with 27 years in a demanding call center environment as a Customer Care and Claims Specialist. Insurance

Detail-oriented

Strong verbal communication

Claims processing

Medical terminology

Excellent work ethic

Sharp problem solve

MS Windows proficient

Energetic work aattitude

Call Center Customer Service and Claims Specialist, 06/2008 to 01/2018 Humana Insurance Company – Cincinnati, OH

Determined customer needs by asking relevant questions and listening actively to the responses.

Investigated, resolved and documented customer inquiries and complaints in a timely and empathetic manner.

Mentored new employees

Researched all clinical documentation and adjudicated medical claims. Educated customers, providers and employers about Humana's products and services. Grievance and Appeal Specialist, 05/2006 to 06/2008 Humana Insurance Company – Cincinnati, OH

Responded to complaints, grievances and appeals while adhering to all regulatory accreditation and internal processing timeliness and guidelines. Collected, analyzed and interpreted information to resolve non-routine business-related concerns.

Built Humana's brand image with employers, members, brokers, consultants, physicians, hospitals, regulators and legislators by providing effective and efficient service. Customer Service Representative, 07/2000 to 05/2006 Humana Insurance Company – Cincinnati, OH

Investigated and resolved customer inquiries and complaints in a timely and empathetic manner.

Education

Accomplishments

Associate of Science: Health Management, 2004

Cincinnati State Technical and Community College - Cincinnati, OH Recognized with a STAR Award for training and mentoring new hires Received Quarterly Top Performance Recognition for exceeding departmental goal of 95% or better.

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