Customer Service Representative
Resume:
Nancy Figueroa
New York NY 10027
*********@*****.***
Objective: To secure a Position that offers new Challenges and opportunities
Experience: Claims\approver New York Bronx NY 10461
Customer service claims rep 12/01/2013
• Inputs claims into systems, maintains pending files, matches professional claims to the
appropriate file and distributes new mail
• Reviews, processes and pays claims
• Handles incoming calls from policyholders, insurers and other external or internal customers
promptly and professionally
• Proven strong analytical skills, including demonstrated experience identifying and quantifying
problems and providing effective resolutions when dealing with multiple issues
• Determines proper payees for payment to assure that the Company is fully discharged from
liabilities associated with claims alternatives.
Experience: Medical Management \ Affinity Health Plan New York Bronx NY 10461
Customer service Representative 10/01/2012- 11/01/2013
Take incoming calls while checking eligibility and answering questions and inquiries about certain
procedure codes.
• Setting up authorization for procedure that are needed while verifying, providers eligibility
facility information to assure that patients received treatment that is needed.
• Contribute to team effort by accomplishing related results as needed.
• Approve certain procedure as departmental policy; while requesting clinical, attaching to
events already on file.
• Providing status on authorization while regulating that company stays within compliance
time frame by following up with pre-nurses and assuring provider’s and members that request
are being review.
Affinity Health Plan New York Bronx NY 10461
Customer service Representative 03/01/2010- 10/01/2012
Take incoming calls answer member inquiries about plan benefits and in network providers.
• Update demographic information on members account including Pcp changes and assisting
caller with any ongoing issue that needs to be address and monitor for resolution.
• Check on claims, premiums provide information and transfer to appropriate departments
through - out the office.
• Send out forms and letters as requested by providers and clients while being sensitive to their
concerns and needs.
• Provided eligibility to clients and providers on members account.
Distinctive Personnel\Affinity Health Plan New York NY 10165
07/0109 -10/01/2010
Receptionist
• Answer multiple telephone lines at a very high pace environment for insurance company.
• Answer incoming calls and questions then transfer to proper extensions throughout the office.
• Handled customer inquiries and complaints in a professional manner.
Education:
State Certified as Insurance Broker for Accident & Health 07/12/2008
The City College Of New York 01/24/2007
High School Equivalency Diploma
Skills: Clear and concise written and oral communication skills.
Faxes,copy and computer literate Bi-lingual Eng\Spanish.
Reference upon request
Contact this candidate