Customer Service Representative
Resume:
T AM I KA L. WESLEY
**** ******* *****, ******, ** 75217
************@*******.***
Objective: To pursue my career in the healthcare insurance field. I have vast experience
performing tasks as a medical claims processor and coder, data entry clerk, proof-reader,
switchboard operator, mail distributer, customer service representative, inventory
shipper/receiver, and medical appeals analyst.
Work H istory:
Molina Healthcare of Texas-Inquiry D / A Resolution Coordinator (Oct. 2012-Feb. 2014)
Processed and completed Provider appeals for Medicaid, CHIP, Star, Star+
Researched and completed State complaints from H HSC for Medicaid, CHIP, Star,
S tar+
Performed and completed related special projects as assigned from supervisor
Aetna, Inc.-Claims Benefit Specialist (Nov. 2009-Oct. 2012)
Verified and corrected error messages on submit ted medical claims for Medicaid,
C HIP
Manually adjusted medical claims as needed
Performed and completed related special projects as assigned from supervisor
Dell /Perot Systems (temporary work)-Claims Analyst /Team Lead (Feb. 2008-Nov. 2009)
Managed Perot employees on project site of Aetna, Inc.
Verified and corrected error messages on submit ted medical claims for Medicaid,
C HIP
Manually adjusted medical claims as needed
Performed and completed related special projects as assigned from on-site supervisor
Tax Saver Plan-FSA Claims Administrator (Jan. 2006 – Feb. 2008)
Verified eligibility of submitted f lex spending account claims
Data entered and processed submit ted f lex spending account claims
Dell /Perot Systems (temporary work @ Great West Healthcare)-Customer Service
Representative (Aug. 2004 – Jan. 2006)
Responded to provider and member inqui ries via phone
Resolved eligibility, benefits, enrollment, and payment issues
Jacobson Group (temporary work @Cigna, Inc.)-Claims Analyst /Processor
Verified and updated ICD-9 & HCPCS codes on submit ted medical claims
Processed submitted medical claims for correct payment.
Blue Cross Blue Shield of Georgia (Mar. 2000-Nov. 2003)
Claims Associate I I I
Verified HCPCS codes on submitted medical claims
Data entered and processed submit ted medical claims for proper payment or denial
Customer Care Associate I I & I I I
Handled and resolved calls regarding benefit and claim issues
Handled supervisory calls regarding benefit and claim issues
Processed and adjusted submit ted medical claims
S kills:
M icrosoft Word, Excel, Outlook and PowerPoint, 10-key calculator, Typing, In ternet
E xplorer, Google Chrome, Windows 95, 98, XP and 7, NASCO, Adobe Acrobat Reader,
E ncoder Pro, Q-Care, Document Direct, Quicken Basics, XNet, Power M HS, I t rack, IView,
Customer Care System (CCS), Image Retrieval, Ben-Gui, Ben-Rumba, Linux, Telnet,
Q NXT, SharePoint, GEMS and similar billing software
Education:
Northwestern H igh School-Detroit, M I (Aug. 1986-June 1990)
General Studies
Randolph Vocational/Technical Center-Detroit, M I (Sept. 1988 - June 1989)
Word Processing
PSI Institute of Michigan-Southfield, M I (Jan. 1991 - Feb. 1992)
Word Processing/Data Ent ry
Sanford-Brown College-Dallas, TX (June 2014 - Present)
Medical Billing & Coding
R eferences Available Upon Request
Contact this candidate