Customer Service Manager

Ischara Montgomery

Claims/ Benefits Service Rep

Lawrenceville, GA

acb7sj@r.postjobfree.com - 770-***-****, 770-***-****

My goal as a customer service/ benefit representative and insurance verifier is to strive for success in making

sure that my customers are happy and satisfied. I'm very multi-tasked goal oriented reliable and dependable.

The number one thing in my role is making sure that I'm a team player and strive to get the job done. In my

role the customer is always right.

WORK EXPERIENCE

Lead Benefit Service Representative

ADP - Alpharetta, GA - February 2013 to Present

My responsibility is providing all Health and Welfare administration services to our HR/B Administration

Services clients. This includes Major Account Services clients with between 50 and 150 employees. I work

closely with the client's Human Resource staff and employees to respond to benefit related inquiries and

questions, also works closely with a client's benefits provider(s) to resolve eligibility issues and to escalate

service and/or claims issues on behalf of employees. Process all pended enrollments, life events, and

employee changes submitted by employees via Employee Access as well as such requests submitted via

telephone. Process all such requests in accordance with documented client procedures. Process Evidence

of Insurability (EOI) forms in accordance with documented customer procedures. Ensure that all work is

completed in accordance with published service level agreements. Proactively contact the client's Human

Resource (HR) and benefits staff to assess their satisfaction with services provided. Establish and maintain

effective relationships with clients and gain their trust and respect. Provide tier one support to HR/BAS clients

and their employees who contact the service center. Communicate benefit changes and policy as necessary.

Research and resolve complex employee benefit problems and questions. Coordinate tier two support with

the designated Customer Lead, Client Services Supervisor, or the Account Manager. Work closely with benefit

providers to resolve eligibility errors generated by benefit providers. Serve as an employee advocate to

benefit providers for claims issues. Perform all Quality Assurance (QA) procedures as specified in the client's

Administrative Procedures document. Perform special projects as deemed necessary by the Client Services

Manager. Experience, Skills, and Academic is my main priority of my job.

Claims/ Benefits Service Rep

AonHewitt - Orlando, FL - June 2011 to February 2013

Responsibilities with this job title is explaining customer benefits to them that they receive through their

employer. We are a Human resource benefits corporation facility. I would have to explain any benefits that lead

to claims that have been processed for medical dental vision dependent care health care spending accounts

401k Leave of Absence and etc. I would also have to process claims for 401k loans or hardship withdrawals that

the customers are taking out against there retirements. I would have to make sure that the customer qualifies

for the loan or hardship and set up the transaction to direct deposit into there banking accounts. Another one of

my responsibilities were processing claims for customers that called in to take a leave of absence and it has to

be approved through a case manager. I would basically explain to the customer there FMLA credits short term

and long term disability that they have available to them also explain to them of the different HIPPA forms that

will need to be signed and returned to us to process the claim and also to get the leave of absence approved.

Once the claim is approved I will have to request the customers medical file in order for the case manager to

have the doctor s notes for the customer so she will have that info for that customers file. Whenever our tuition

department gets behind I will also assist them in processing tuition claims for the participates that are seeking

reimbursement from there employers for course's that they are taking to receive a degree or certification in

their career with the employer. I would have to go by the guidelines of the client's expectations in order to

make sure that the participate meets all requirements in order for me to process the claim and have the claim

payable for reimbursement.

Claims/Benefits Service Representative

Long Term Care Group - Maitland, FL - April 2008 to June 2011

My responsibilities are to take phone calls from customers that have a long term care policy with us help them

and provide service to where as credit card payments for their premiums co-pays and deductibles that needs

to be paid in order to start a claim for services. Explaining there benefits to them and sending out duplicate

copies of the policies was another one of my responsibilities. I would also have to submit claims for nursing

homes and private nurse's that come into the home to care for the chronic ill patients. Another one of my duties

are setting up the patients accounts to make sure that all patients demographic information is entered into the

system right so the policy can go through underwriting to be approved. I was also responsible for explaining

the patients benefits to them about how the long term care benefits works. If a patient is chronically ill to where

as they didn t have long to live I would at that time work with the patients benefits center to set up additional

long term care claims for hospice to come into the home. I would then at that time explain to the power of

attorney how the patients FMLA benefits will work and how the long term disability works. I would only give

this information to a person that is on file and have signed the HIPPA forms that we have on file.

Title Service Representative

Fairfield Resorts - Orlando, FL - August 2004 to February 2008

My responsibilities with this company was taking calls from timeshare owners that wanted to make payments

for there timeshares. I also book appointments for the customers whenever they wanted to plan a vacation to

use the timeshare. I also had to prepare the deed's for the customers whenever the contract has been fulfilled

and the mortgage have been completed. I did correspondence work as well for as adding on authorized user's

updating demographics and etc. I had to perform skip tracing in order to get a good address or demographics

for a customer when we were not able to contact that customer in reference to there timeshare.

Patient Service Specialist

Walgreens Healthcare - Orlando, FL - January 2003 to January 2005

My responsibilities with this position was taking calls from customer that needed to get there prescriptions filled

and pharmacist that needed assistance in getting a prescription to be approved by the insurance company.

Had to be very familiar with different types of medications the dosage and the manufacture that the medication

was made by. I would have to do 3rd party authorizations pre-authorizations and also submit Medicaid claims

as well. I would have to also verify coverage to make sure that the customer had active coverage. We dealt

with different insurance companies (Aetna Cigna Medicaid United Healthcare Medica Humana Medicare and

etc). I also dealt with coordination of benefits when it deals with one insurance company being the primary

payer and the other is the secondary. I took credit card payments from the customers that did do the mail

order services for there medications.

Assistant Customer Operations Manager

BellSouth Mobility - Lake Mary, FL - September 1997 to December 2002

I was responsible for taking calls from irate customers when they complain about one of the customer service

representatives were not able to give them customer satisfaction. I was also responsible for a small team of

people (12) making sure they met there quality scores and job requirements. I did one on one's with my team

to make sure they stayed in a 90 percentile and meeting and exceeding there qualifications. I would have to

submit time cards for the end of the work week for the employees to be paid for the next pay period. I would

also have to do counseling for some of the employees that were not meeting or exceeding there expectations

of their roles. Always had to engage in meetings with other manager s for improvements for the call center

and business. I had to send over a report to the credit bureau's when a customer account falls delinquent and

there has not been any activity in the last past 60 days. I also had to work on a microfiche machine to look for

misapplied payments when they were applied incorrectly to the wrong account.

EDUCATION

Associate Degree still in school in PHR certification

Devry University - Lawrenceville, GA

2013 to 2015

GED in General Education Courses

Seminole Community College - Sanford, FL

1989 to 1989

SKILLS

HR Administration, Call Center Management. Team Lead

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