Customer Service Representative

Katrina K. ANDREWS

**** ******* ****** **********, ** 15132 ? 412-***-****

? ******************@*****.***

PROFESSIONAL SUMMARY:

Dependable, self-motivated individual seeking a challenging career changing

opportunity, which would allow me to utilize my academic background to

assist me to obtain experience, employ my strong analytical skills and

enable me to make a positive contribution. Have an educational background

in fraud and forensics and business in addition to customer service and

insurance experience. Possesses proficiency in research and reporting.

Excellent verbal and written communication skills. Fosters collaborative

working relationships with other departments with a very strong focus on

customer service. Possess the highest degree of integrity, supported by a

flawless record of maintaining confidentiality.

EDUCATION:

CARLOW UNIVERSITY, Pittsburgh, PA August 2014

MS, Fraud and Forensics

3.78 GPA

Associate member of ACFE

POINT PARK UNIVERSITY, Pittsburgh, PA December 2008

BS, Business

3.93 GPA

Dean's List

Alpha Chi Honor Society

BRADFORD SCHOOL, Pittsburgh, PA October 2001

ASB, Office Administration

4.0 GPA; Director's List - Graduated with highest honors

SKILLS:

Windows XP, Microsoft Office 2007: Word ? Excel ? PowerPoint ?

Outlook ? Access ?

Project Management ? Strategic Planning ? Time Management

PROFESSIONAL EXPERIENCE:

AETNA HEALTH INSURANCE COMPANY, Pittsburgh, Pennsylvania 03/2012 - present

Complaint and Appeal Analyst

. Responsible for coordination of all components of complaints including

final communication to member/provider for final resolution and closure

. Serve as a technical resource to colleagues on claim research, letter

content, state or federal regulatory language, triaging of

complaint/appeal issues, and similar situations requiring a higher level

of expertise

. Identifies trends and emerging issues and reports on and gives input on

potential solutions

. Ensure that complaints are handled within established guidelines and meet

company and regulatory requirements

. Completed Aetna Improvement Process Yellow Belt Certification based on

DMAIC principles

. AWEA 3rd Quarter 2013 Nominee

. Accepted into the Leadership in Training Program for 2014 and

successfully completed requirements of program in July 2014

o Facilitated interviews for customer service representatives that we

hired in 2nd and 3rd quarter 2014

o Facilitated champion sessions for Censeo Health outreach and Ownership

for Pittsburgh office employees

o Developed a Second Review Process Improvement that was implemented in

2nd Quarter 2014

o Participated in focus groups for Ownership and Soft Skills

. Review calls and communications that our SIU receives. Research to

determine if fraud or not. Follow up with SIU and the member.

AETNA HEALTH INSURANCE COMPANY, Pittsburgh, Pennsylvania 07/2011 - 03/2012

Oral Grievance Analyst

. Identified member's complaint as defined by CMS (Centers for Medicare and

Medicaid Services) and prepared cases with the required documentation

while maintaining the CMS timeframe for each case

. Interacted with members, providers, medical directors, claims processors,

member services and others, as necessary, to resolve the member's

issue(s)

. Because of my compliance audit scores, I was also chosen to be on a team

of five individuals that audit all Medicare Part D grievances that were

completed by other Oral Grievance Analysts to make sure that they were

handled correctly. In the event that they weren't, I would make the final

follow up and resolution and finish out the case for the member

AETNA HEALTH INSURANCE COMPANY, Pittsburgh, Pennsylvania 11/2010 - 07/2011

Sr. Customer Service Representative

. Answered questions and resolved issues as a single point of contact for

members, plan sponsors, providers and internal constituents

. Assisted internal customer service representatives with account specific

questions and directed them to the correct policy or resource to be able

to assist our members

. Handled escalated issues that were transferred to me from representatives

and attempt to de-escalate the call from going to a supervisor and offer

a resolution for our members

. Aetna Way Excellence Awards Nominee 1st Quarter 2011

AETNA HEALTH INSURANCE COMPANY, Pittsburgh, Pennsylvania 09/2009 - 11/2010

Customer Service Representative

. Answered inbound calls related to Medicare Advantage accounts

. Researched and followed-up with members, as necessary

. Multi-tasked and navigated a variety of systems on a daily basis

ALCOA INC., Pittsburgh, Pennsylvania 11/2001 - 04/2009

Information Assistant, Information Processing Center

. Prepared documents for generating manuals, letters, memos, newsletters,

brochures/pamphlets, reports, spreadsheets, presentations, etc.,

utilizing the Microsoft software package in a high volume environment

. Created graphics for effective data presentations and analyzed output for

maximum impact

. Recommended successful visual aids of high quality for logical, visual

and accurate effectiveness

. Effectively assisted customers with troubleshooting Microsoft software

face-to-face, over the telephone or via net-meetings

. Researched and implemented efficient systems and/or procedures that

identified and integrated cost effective savings and created improvements

in work processes

. Trained and managed employees/clients from our New York office on

PowerPoint applications

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