Customer Service Representative, Data Entry, Accounts Payable
Resume:
Mary A. Brooks
Philadelphia, PA 19151
******.****@*****.***
Summary of Qualifications
I worked as a Senior Account Specialist in the Enrollment and Billing Department of a major health insurance company. I was in this position for 9 years, and with the company for almost 14 years. Along with my senior duties I performed testing for eEnroll which is a web based system used by the Enrollment and Billing Department as well as external constituents such as Brokers and Group Administrators to enroll members. I was the subject matter expert for eEnroll. I documented and reported issues found by our Account Specialists and external constituents such as Group Administrators and Brokers. I participated in the implementation of eEnroll 4.41 in September 2007. I played a major role with initial stages of eEnroll 4.41, including fine tuning the test plan. I also was in charge of the testing for eEnroll 4.41, and was the liaison between the testers and the BITS Department. I was also in charge of documenting and reporting issues found during testing. I researched eligibility for our claims department regarding Medicare, Primary Care Physician issues, etc. using the PEGA system. I processed Mass Primary Care Physician (PCP) changes for Providers that were no longer in our network. I also verified that Medicare primary members were on the Medicare crossover so their claims could process correctly.
Employment History
Blue Cross Blue Shield of WNY October 2000 - July 2014
Sr. Account Specialist (April 2005 – July 2014)
Audited membership applications and certifications and obtained missing information from Group Administrators, Brokers and members. Processed updates, changes and terminations. Reconciled premium payments according to amount billed. Records variance and took appropriate action to resolve outstanding balances in a timely matter. Prepared and mailed arrears and credit letters; requested refunds for terminated groups and individually billed subscribers. Answered questions from Account Specialists, Management, Group Administrators, Brokers and other Departments. Troubleshoot eEnroll issues from Enrollment/Account Specialists, other Departments and external constituents. Tested eEnroll fixes and reporting any issues found in eEnroll. Mentored new Account Specialists. Researched eligibility issues from Claims Department and other departments.
Achievements
Participated in the testing and implementation of eEnroll 4.41.
Account Specialist (August 2001 – April 2005)
Audited membership applications and certifications and obtained missing information. Processed updates, changes and terminations. Reconciled premium payments according to amount billed. Recorded variance and took appropriate action to resolve outstanding balance in a timely matter. Prepared and mailed arrears and credit letters; requested refunds for terminated groups and individually billed subscribers. Tested eEnroll fixes and reported any issues found in eEnroll.
Customer Service Representative (October 2000 – August 2001)
Answered verbal inquiries. This includes claim review, benefits, enrollment and eligibility, provider participation, Medicare, OPL and inter-plan transfers. This involves listening carefully and correctly evaluating and interpreting the information and responding in a clear, cordial manner. Handles all activities associated with handling inquiries from members, other insurance carriers and outside agencies and potential customers.
OfficeTeam March 1999-October 2000
Temporary Agency
Blue Cross Blue Shield of WNY/Data Entry (August 1999 – October 2000)
Enrolled and updated membership records from Legacy to Facets. Data entry and filing.
M & T Bank/Secretary (June 1999 – June 1999)
Answered phones, filed, distributed mail and faxes, copying, greeted clients/customers, and prepared orders for vendors.
Lipsitz, Green, et all/Secretary (March 1999 – April 1999)
Answered phones, filed, typed correspondence, distributed mail and faxes, copying, and Dictaphone.
Education
List Degree and Concentration 1986-1990
Gannon University, Erie, PA
Office Administration/Medical
PROFESSIONAL DEVELOPMENT
QBQ
Certificate in Office Procedures and Technology
Internship at Marine Midland Bank in Corporate Benefits Department
Computer/Technical Skills
Microsoft Office Suite (Word, Excel, PowerPoint)
Lotus Notes
WordPerfect
Microsoft Works
Facets
PEGA
Benefit Focus
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