Resume

Sign in

Customer Service Representative

Location:
Pontiac, Michigan, United States
Posted:
October 09, 2016

Contact this candidate

Eugenia W. Fisher

Phone (248)***-**** or (248)***-****

Email: acwzfz@r.postjobfree.com

https://www.linkedin.com/in/eugeniawfisher

To be part of organization which strives for communication and professional development. Being liaison between organizations and the client to analyze and provide client assessments on quality. Generating analytical information into conditional coaching and training to enhance retention and client relations.

Work Experience

Data Analyst, Bartech Group Southfield, MI

Contingent workforce management, staffing, consulting and BPO solutions organization.

January 2013 - May 2014

Contract employee for BCN/Blue Cross Blue Shield Southfield, MI

Assisted Health Coaches with patient health assessment requirements

Updated provider records, utilizing shared spreadsheets for annual HEDIS measurements

Created and maintain system documentation, including patient and provider outcomes

Ability to analyze raw data and understand results, with ability to think logically and process large levels of data with detailed accuracy

Work closely with leadership to provide data to facilitate problem solving

Run queries against client data from previous years to create and modify reports using Microsoft Excel

Identify discrepancies and recommend changes to improve quality and processes

Caregiver/Home Health Aide, Michigan Department of Human Services

Michigan funded program, assisting family members to assist elderly or disabled family members in identifying and arranging needed services.

June 2016 – Present (Part-time)

November 2011 - April 2014

Participated in case reviews; consulting with physicians for best care for client

Provided transportation as required and 24-hour overnight care as requested

Maintained patient care and household expense record

Claims Processor Great Expression Dental Center/Michigan Corporate Office Bloomfield Hills, MI

Affordable family dental care for Michigan, Georgia and Florida.

May 2010 to June 2011

Transmitted claims for payment or investigation

Updated demographic information for collection

Maintain operator/receptionist desk during breaks

Contacted commercial health insurance groups regarding benefits

Member Service Representative, TheraMatrix Physical Therapy Network Pontiac, MI

Outpatient Therapy Company, which has contracted with other outpatient physical therapy companies to create a national physical therapy network to offer affordable care.

November 2007 to May 2010

Established cooperative relationships with members and providers

Negotiated reduced rates out-of-network providers for services

Maintained client records, by recording grievances and resolutions

Requested referrals/script from primary care providers for specialty care

Conducted credentialing process and updated annual credentialing records

Communicated with Directors to identify member trends and extended offers to providers to join network

Claims Processor & Claims Customer Service, Value Options dba Beacon Health Wixom, MI

Behavioral Health and Wellness Company, serving several of the United States Military

August 1999 to September 2007

June 2012 to August 2012

Investigated and resolved complex claims, authorization, eligibility and provider issues

Research provider discrepancies and executed claims adjustments

Participated in the implementation training team for new systems and processes (Facets)

Utilizing Facets systems to research and track inquiries from members, providers and internal work areas

Provided member/provider with referral and initial assessment visits

Providing members with annual claims account records for HSA

Supported the transition of accounts: closing of case management and claims

Contracting providers for updated association and provider credential changes

Working knowledge of multi-line phone system and call center standards

Communicating member benefits and understanding of coordination of care

Knowledge of HMO, PPO, POS, Medicare, Medicaid, EAP and TriCare

Education

Bachelor of Art in Applied Behavior Science in the College of Health, Human Services and Science

September 2015

Ashford University San Diego, CA

Minor-Child Development



Contact this candidate