A B O U T M E

ERICKA N. JONES

GRIEVANCE & APPEAL COORDINATOR

SUMMARY OF QUALIFICATIONS

To obtain a position which effectively manages the grievance and appeal process for a top-tier insurance provider. Skilled Customer Service professional adept at resolving issues. Experienced Pharmacy Technician skilled medication dispensing in both hospital and retail settings. EXPERIENCE

GRIEVANCE AND APPEAL COORDINATOR

12/2008 – 12/2011

Managed analysis, evaluation, resolution and response to customer complaints (grievances) regarding service received from medical and pharmaceutical providers as well as rejected claims and services

(appeals.) Conducted internal and external research as appropriate to address grievance and appeal cases for subscribers and providers. Processed appeals and grievances in accordance with established deadlines.

AUDIT ANALYST

7/2006 – 12/2008

Responsible for coordination and implementation of projects at a divisional and corporate level involving efforts to increase efficiency of operational procedures, controls and performance. Providing analysis, processing and expediting of high priority operational transactions including but not limited to dispute resolution. Participation in system testing as well as development of internal procedures and internal controls to ensure data security and integrity. Responsible for direct communication with internal and external customers PHARMACY TECHNICIAN

09/2004 – 07/2006

Analyzed and evaluated pharmacy and physician inquiries received via telephone regarding commercial and Medicare D pharmacy benefits, prior authorizations, step care therapy, on-line prescription claims and claim rejects.

CUSTOMER SERVICE REPRESENTATIVE

07/2001 – 09/2004

Responsible for addressing and resolving customer inquiries received by telephone involving a variety of claim and benefit issues. SKILLS

Grievance & Appeals

Coordinator with 10+ years of

experience working for a

Top-Tier insurance company

C O N T A C T

ac94l2@r.postjobfree.com

313-***-****

19230 Mackay

Detroit MI 48234

E D U C A T I O N

WAYNE COUNTY COMMUNITY

COLLEGE

Liberal Arts Coursework

2001

CROCKETT ADULT EDUCATION

Pharmacy Technician

Certificate

1996

Appeal & Grievance Administration

Research and Analysis

Customer Service

Data Entry

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