Customer Service Manager
Resume:
BARBARA CASEY-COVERSON
Dallas, Texas 75287
***************@*****.***
WORK HISTORY
Sept 2014-Jan- 2016
Trizetto Solutions Claims Service Rep.
Assistance clients via a ticket system to claims request (ie Payer Enrollment, Validation of NDC codes, Missing Remits, claim rejection). Payer Enrollment verifies that all the documents are the updated forms and they are filled out properly. Validation of NDC codes review the codes with the FDA National Drug Code Directory and opening Operational jobs to have IT relax the edits or add the edit. Missing remits Emdeon, Gedi EDI, Claim Net & contacting payers to research issues via phone or email. Claims rejection either by the payer on the front end with their EDI dept. or issue related to Claimlogic system editing. Assisting Executive Account Manager with daily research on issue of non-covered drugs, duplicate claim submission, pulling and releasing test files, and assisting with the conversation to the ICD-10.
Feb 2014- Sept 2014
Citibank Merchant Credit Card Services
Duties included answering general specialist credit cards question from the cardholder & store clerk regarding billing, authorizing purchases, assistance with online payments, setting up pay by phone, closing accounts and applying misappropriation payment to wrong account. Resolves product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution
Nov 2013- Dec 2013
HLP Solutions Temp. (PFS Webs) Fraud Analyst I
Proactively monitor and review electronic account and transaction data for suspicious activity and possible fraud. Approve or cancel sales orders in accordance with pre-established fraud guidelines. Review received verification documents for accuracy.
Coordinate the investigation of any fraud issues with the appropriate fraud investigative unit or agency. Verify required documentation and assist customer service representatives with questions or issues regarding customer accounts received via email correspondence
Nov 2012-Oct 2013
AAA P&C Claim Adjuster
Having immediate contact with an insured or their representative on any claims assigned; responsible for denying a claim if not covered or obtaining or writing an estimate and requesting payment for covered claims; take phone calls from and working with insured’s or their representatives, agents, contractors, adjusters, etc., on any questions regarding the claim; review mail from outside staff adjusters, independent adjusters, contractors, etc., and requesting payment for covered claims or preparing denial letter for non-covered claims; request additional information from insured’s, adjusters, contractors, etc., as needed; determine if there is salvage or subrogation potential, if so, note it on the file and e-mail Claims Supervisor.
April 2012- Sept 2012
Express Temp (APS Healthcare) Medicaid Specialist I
Communicates with a wide variety of external contacts including Colorado Medicaid members, providers, facilities, claims payers, and insurance companies. Addressed provider inquiries related to the Prior Authorization Request process and initiates review or process by phone and fax. Entering information in the Colorado’s Medicaid system and approving DME, Audiology, and Vision supplies of less than $1,000. Maintained a call level of 40-50 calls per day & keeping a high level of customer satisfaction with timely problem resolution. Provided customer service and conducts intake in a call center environment. Assistance the dental department with entering Prior Authorization Request (PAR) into the America Medical Review website for review.
EDUCATION
Aug 2014
UT Arlington - Arlington, Texas
Education Level: 4+ years college
Major: Bachelor in Nursing
GPA: 2.75
Status: Not Completed
INSURANCE SYSTEM:
XactAnalysis AS-400 Assistance
JWalk-Seagull ISO ClaimSearch
First Notice of Loss WorkDesk
E-Doc FastLane
ADJUSTER LICENSES:
OK, TX & CT
COMPUTER SKILLS:
Typing Speed: 35 WPM
Peripheral Devices (Scanners, Printers, etc)
Email Software (Outlook, etc)
Word Processing Software (MS Word)
Contact this candidate