Customer Service Representative

Sandra Smith Jones

***** * *********** *****

North Little Rock, AR 72117

Cell - 501-***-****

Email: **************@*****.***; **************@*****.***

GOAL: Provide excellent customer service every day.

QUALIFICATIONS:

•Work well with minimal supervision

•Ability to prioritize and remain focused under stress

•Able to learn new concepts quickly

•Know how to research system for answers when needed

EXPERIENCE: TalentWave for Dell Technologies

4601 DTC Blvd, Suite 650

Denver, CO 80237

May 2016 to present

HC & Insurance Ops Associate

•Emblem Account

•Process claims online through QCare/Amysis/Citrix

•Read edits and apply guidelines

•Reference Cmore documents for further information

•Pay/deny claims or apply pend codes as instructed

EXPERIENCE: Blue Cross Blue Shield

601 Gaines St

Little Rock, AR 72204

June 1993 to December 2015

Claims Specialist

•BlueCard Host and Home

•Process claims, sort and work various reports

•Distribute work among coworkers each morning

•Assisted co-workers, new hires, other supervisors, customer service and provider reps

•Prepare material and instructed new hires on how to process claims in training room

•Update desk procedures when necessary

Customer Service Representative

•Provide professional customer service

•Document reason for call as well as how it was resolved

•Contact providers at customers request

•Also assisted providers with claims payment issues

•Perform follow up to ensure claims were adjusted or paid correctly

•Speak with customers on phone as well as walk in customers

EDUCATION:

•High School Diploma

•Passed several classed through Blue & You University offered through the company

SYSTEM KNOWLEDGE

•Microsoft Word

•Excel

•Facets

•GCPS

•ITS/IMS

•AHIN

•AMYSIS

•ProvWeb

•FEP

•Medipak

•Citrix

•ORR

•CSW

•MRR

•Filnet

•Blue2

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