Customer Service Representative

Veronica L. Herring 203-***-**** Hamden, CT ****4

***************@***.***

SUMMARY

Self-motivation, detail orientation, and sound customer service skills.

Utilize excellent communication skills to interface effectively with

management, staff and clients-Consistent recipient of "Excellent"

performance review.

EXPERIENCE

United Health Care 01/14 - 07/14

Data Load Analyst - involves the updating of provider and group

demographics in NDB and PIMS. Update rates, as well as cross referencing

provider and group locations. Work consists of researching providers

demographic who are participating with The Tricare Military and Veterans

policies to make sure location is valid before updating the computer

system.

United Health Care 10/12 -

12/13

A Loader for Tricare contracts dealing with Physician and Ancillary

providers. The job requires the ability to perform initial review and

research. Author and execute contract in Emptoris. Load contract

information in emptoris. Also compare NDB demographic verification of the

contract with UNO.

Ability to read and interpret a standard provider contract.

. A customer service representative with experience in all aspects of

commercial health insurance: as well as Medicare, and

. Familiarity with the general provider demographic and their purpose.

. Logical ability to follow a workflow and troubleshoot potential gaps.

Yale Medical

05/12 - 08/12

Provide data entry support for the Central Registration department.

Updating patient information sent over by the hospital for emergency room

visits. As well as calling patients to verify if the demographic were

current and correct.

. Position requires extensive knowledge of insurance including Medicare,

AARP

. Worked with IDX and Centricity system to Verify patient information.

Well Point UM Rep Department

06/11 -05/12

Supplied data entry support for the Utilization management department.

Helped with dividing authorizations, that came in the computer system

between CT, MN, and NH.

Well Point Behavioral Health North Haven, CT

12/10 - 04/11

Customer Service Representative

Provide customer and provider support for mental health. Responsibilities

include provider referrals for mental health professionals, verifying

benefits and copayments, also verifying authorizations, and setting up

authorizations for care managers.

. Position requires extensive knowledge of insurance including Medicare

. Established excellent client relations via committed service and

follow through

Health Net Shelton, CT

12/05 - 07/10

Customer Service Representative/Claims Analyst

Provide customer and provider support for commercial medical providers, and

members including Medicaid, and Medicare members, and providers.

Responsibilities include provider referrals for a vast number of provider

specialties verifying benefits and copayments, researching claims,

verifying authorization status, and maintaining and updating membership

database.

. Position requires extensive knowledge of insurance including Medicare,

Medicaid, and Commercial policies

. Established excellent client relations via committed service and

follow through

. Selected to assist the prior authorization department, to reduce the

backlog and field calls

EDUCATION

1994 - Stone Academy (Hamden, CT)

CERTIFICATE IN WORDPROCESSING (Major: Secretarial Studies)

Computer and Office Skills: *IBM pc compatibles *WordPerfect 6.0 *Lotus 1-2-

3 *MS Office 95 * Medical Insurance * Typing (35 + wpm).

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