Customer Service Medical

S helester Ha rper

**** ****** ***** ******, ***** 75061 Telephone: 214-***-**** Email: ***********@*****.***

Experience:

Allstate Insurance, Irving, Texas

**** – June 2014 ATO-Processing Support Associate III

-Trainer

• Sort, open, and batch USPS undeliverable claim checks. Prepared and reported work condition report/s to department

managers. Contact insured, claimants, attorneys, medical providers, agents and vendors for additional information,

updated systems accordingly. Document the claim file and re-mail the check/s. Respond to voicemail messages from

t he customer's service mailbox. Handle telephone inquiries timely, resolve complex insurance inquiries, problems or

complaints requiring research investigations, coordination, calculation, and/or resolution of discrepancies. Participate

and or lead work project in support of business needs. Maintain open and positive communication representing the

business in a professional manner.

• Assist with the handling of claims that fall within the PIP/Med Pay claim segmentation. Review the claim file,

making initial customer contact, answering customer inquiries, resolving billing exceptions, clearing bills, and

p rocessing medical and non-medical documents. Contact customer’s venders, medical providers, attorneys, third party

insurance carriers and others to ensure necessary file information is obtain for final claim payment processing.

• Auto Express, Review documents and claim and Input data information into system in a timely manner according to

company procedures. Assist in the training of new or less experienced employees and provide feedback to leadership

possible improvements in enhancement training effectiveness. Work independently displaying good judgment and

p roblem-solving skills consistently follows security and compliance regulation for all products.

Team Lead -Trainer -SR.

2004 – 1999

Insurance Processor Specialist III

• Responsible for the day to day operations including data entry, typing, filing and mailing medical documents.

Received sorted and index medical bills for claim number and desk location then mail processed items to MCO.

I nput data and information into system in a timely manner according to company procedures.

• Investigate unidentified customer payments. Provided exceptional customer service regarding inquiries misapplied

mortgage payments, and customer policy refund corrections. Request check copies from customers and banks,

investigated and correct encoding errors, void and reissue checks, void and apply payments to correct policy.

I nvestigate overages and shortages, print and prepare checks for mail out. And cleared C323 list exceptions.

• Bank Reconciliation, balance and reconcile bank accounts, process related general ledger account, CPU system

balancing, Post journal entries to corporate General Ledger accounts. Review and process 180 Day checks

• Fixed Asset creation, Transfers and retirements, return items

SR. Remittance

1999 – 1985

Management Specialist II

• Provide support and assistance to regional office and their agent for all aspects of agent remittance reconcile account,

investigate discrepancy, policy correction for payment received in agent’s location. Balance Agents end of day

remittance report received via mail

• Reconcile balancing for the 1310 account. Investigate research and resolves payments related postings voids and

reissues or mist-applied payments, refunds checks, encoding errors. Charge-offs and cant finds check errors

unidentified payments.

• Cleared list 22 unmatched items on the unmatched list which consist of late payments partial payments, payment

under review by underwriting, and payments for which the policy has not been release, payments that have incorrect

policy information. Review and reconcile List 30 credit balance workstation that includes the following items: early

payments for renewal, payments for endorsements that have not yet been processed. Duplicate payments, and

misapplied payment.

• EZ-pay and Payroll deduction Answer customer service inbound and outbound call in a professional and courteous

manner. Maintain positive customer relationships answering all account billing, bank draft, and setup bank

information for drafting. Served as primary processor for the daily PEP+ collection and distribution. Through one

centrally located system, oversees bank transmission to ensure data wire was received, and assist in resolutions for

t ransmittals that was not received.

• Served as Subject Matter Expert, provided support to home-office, local management working in conjunction with local

I T department to evaluate programming issues. Received process and balance the ACH file, transmit file to our

respective banks/customers ensuring totals are receive from various ACH customers were all collected and balance

communicate any file discrepancies or various. Also corrected file errors and unresolved returns, adhering to

deadlines.

Education: Winfield High School Jackson, Mississippi

1979/1980 Diploma

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