Customer service - clerical insurance industry

FELICIA MCNEAL

*** ******* *****

Dallas, GA. ***32

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

813-***-**** (c)

SUMMARY

Professional, goal oriented individual that works excellent under pressure. I thrive in a fast paced, dead line driven environment without sacrificing accuracy, details and efficiency. I hold myself to a high standard of customer service, excellent sense of urgency and problem solving skills. I possess a strong work ethic, excellent communication skills. I’m quick to learn, have the ability to maintain excellent professional relationships with coworkers, manager, clients and vendors. Although my work experience has been primarily in the medical insurance industry, I am confident that my clerical and administrative support skills are transferable into other fields.

EXPERIENCE

Priority Care Solutions, Tampa, FL (Worker’s Compensation) 3/2015 - 5/2015

Intake Specialist

Maintained an exceptional customer service level

Received new orders via telephone, fax and web portal

Entered all new referrals into CARE

Maintained all incoming faxes and distributed accordingly

Ensured all required demographic and order instructions fields were complete

Assigned new referrals based on rotation to Care Coordinators and saved on Excel Spreadsheet daily

HUMANA, Tampa, FL (Medicare and Medicaid)

Customer Care Specialist 10/2013- 2/2015

Receive documents and resolve customer inquiries by using established best practices

Educate customers, providers and employers about Humana’s products and services over the phone

Educate members on Medicare Advantage plans and Medicaid plans

Comply with HIPPA and CMS regulations

Educate members and providers on Claims

Build lasting relationships with Humana’s customers

Provide benefits, copays, deductible, and prescription cost for members

PMSI, Tampa, FL (Worker’s Compensation) 10/2005-05/2011

Customer Service Specialist I

Assisted in meeting the demand to provide injured workers with services and equipment through contracted vendors as ordered by adjusters, nurse case managers, and PMSI representatives

Supported Referral Intake and maintained an exceptional customer service level

Served as a liaison for vendors, adjustors, nurse case managers, sales professionals and injured workers to secure delivery of product/service through vendor negotiations to effect cost containment for the payer and secure the best margins for PMSI

Customer Service II (Promotion)

Arranged travel for injured workers such as air flights, trains, hotels, and ground transportation

Provided interpretation/translation for doctor appointments

Assisted the billing department with transportation invoices

Worked with supervisor and carrier to determine appropriate equipment, services and medications as related to diagnosis and as referenced through service/product knowledge

Supported management on other projects and initiatives as assigned

Doctors Laboratory, Valdosta, GA 09/2002-07/2005

Client Relations Representative/Patient Representative

Responsible for pulling drug screens for 227 companies

Set up and modified client accounts

Trained new employees for department and responsible for work instructions

Received customer requests by telephone or mail, analyzed requests and provided information requested

Acted as liaison between Customer relations and other departments for order completion

South Georgia Medical Center, Valdosta, GA 01/2001-09/2002

Certified Patient Assistant

Responsibilities included but not limited to assisting patients with transferring, lifting, standing and walking in the Rehabilitation Unit

Additional Skills

Use various classification systems for insurance purposes such as CI (Customer Interface), Mentor, Argus, RX Nova, Physician Finder, Pharmacy Finder, Outlook, E-billing, RODEO, and NPPS

EDUCATION

Dodge County High School – 1993

Concorde (Medical Office Administration) 2012-2013

Medical Office Administration

Medical Terminology • Microsoft Office Practice/Procedures

Medical Insurance Billing • Microsoft Office 2007

Medical Coding • English & Math

CPR Certified • Billing Software Application

References Available Upon Request

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