Microsoft Office Customer Service
Resume:
Judy Applebaum
Hoffman Estates, IL 60169
acrn45@r.postjobfree.com
QUALIFICATIONS:
Over 15 years experience evaluating and processing life, medical and disability claims.
Excellent communication and customer service skills.
Easy to train and love learning new things.
Solid Microsoft Office and internet skills.
Clear understanding of PHI and the privacy act. Annually updated on PHI and HIPAA rules.
Proven ability to make sound decisions in a timely manner while meeting the quality and production requirements.
PROGRAM/ SYSTEM EXPERIENCE: Availity, Ecare, NDAS, Medcollex, Meditech, CITRIX, ClaimFacts, RIMS, LEXISNEXIS, Internet, SIEBEL/ORACLE,OFAC, GENELCO, FINEOS/STAR, EBIX Health/FACTS (Fully Automated Claims Transaction System), WMS, Bridger, SharePoint, Microsoft 1997, Microsoft Office 2003 and 2007, Microsoft Office Suite, Excel, Lotus Notes, PowerPoint and Publisher.
HEALTHCARE FINANCIAL RESOURCES INC through Mark/Ryan Associates Schaumburg, IL Claims Representative March 2015-July 2015
Secured status and payment of outstanding medical bills with insurance carrier’s for an assigned hospital both through internet resources, specific insurance computer programs and phone calls.
Pended claims for a follow up call with the patient or insurance carrier.
Composed letters to advise the patient of what is needed to bring the claim to a full resolution.
BENEFIT EXPRESS through Advanced Resources- Schaumburg, IL
Customer Care Specialist April 2014-July 2014
Enrolled members in their group plan and assisted members with logging into their company’s website to view their benefits.
Answered incoming calls, escalated any issues that require additional research to solve the member’s questions.
Peer reviewed processed flexible spending claims for accuracy.
DEARBORN NATIONAL LIFE INSURANCE-Downers Grove, IL
Senior Life Claim Advocate 2010-2013
Analyzed complex and in-depth claims for Group Life Insurance, Critical Illness, Accidental Death and Accelerated Death coverages and determine if benefits are due or a denial of benefits should occur based on interpretation of the insured’s plan language.
Composed detailed denial letters to insured’s and advised the insured’s company of the claim denial.
GROUP ADMINISTRATIONS, LTD- Schaumburg, IL
Senior Medical Claims Examiner 2003-2008
Reviewed medical and hospital claims for assigned groups from inception to closure.
Handled all telephone calls, emails and correspondence from Human Resource Benefit Managers, insureds and internal customers.
UNICARE INSURANCE COMPANY-Schaumburg, IL
Claim Policy Specialist 1999-2002
Sole person in the Schaumburg office acted as a liaison between the claim staff and the medical directors and presented cases to the doctor’s for review.
Responsible for making sure all employees followed the updated policies and procedures for the company.
Maintained detailed spreadsheets on Excel as to the status of each referral, Department of Insurance complaints and suspect/fraudulent providers.
EDUCATION:
Dominican University-Bachelor of Arts (Communications)
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