Customer Service Insurance

Cynthia Wallace

Charlotte NC Cell: 704-***-**** E mail: ************@*****.***

I am seeking employment to be an active employee who contributes to the team and the Mission, Vision, and Values of the organization. Attributes include interviewing, data entry, and customer service. Provide excellent performance by transferring my experience, knowledge and skills into value for the organization.

Effective Communication Skills...Analytic Skills...Problem Solving Skills...

Business Administration...Insurance ...Personal Injury...Civil Litigation...

Workers Compensation…Licensed Insurance Agent…Case Manager

Exercise independent judgment and decision making abilities, and a high level of confidentiality utilizing skills that include laws covering aspects of commercial transactions. Uphold ethics standards of the organization while working with members of the team and other professions. Work with financial institutions and other members of community to exchange information and assist clients in need of assistance. Abilities include organization, multi-tasking, and managing time in a fast paced, high volume environment. Expert at research techniques and vast knowledge of disability, insurance, criminal and civil law practices.

Professional Summary

Insurance Telesales Agent,

Zerox, Charlotte, North Carolina 08/2016- 02/2017

• Communicates with claimants, employers, and various medical professionals to gather information regarding the application for continued or new benefits of coverage.

• Conducts investigations to determine whether or not to accept claimants for upcoming year based on relationship. Approves or denies benefits accordingly.

• Responds to various written and telephone inquiries including eligibility, approval/denial determinations, status and continuation or closure of benefits.

• Updates and accurately documents system and claim files on actions taken. Establishes future action plan and case direction.

• Maintains the established customer service, production, and quality standards.

• Evaluates and refers appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, Social Security, and Subrogation.

• Identifies, calculates, communicates, and follow-up on overpayments.

Document Reviewer,

DTI, Charlotte, North Carolina 06/2015---11/2015

• Maintain document control, tracking reviews, case files.

• Accurately file electronic copies of plan documents and amendments and related filings.

• Type and code legal correspondence in tracking system.

• Assists the Legal Team in properly identifying, maintaining, organizing, and filing litigation related records.

Case Manager,

Department of Social Services, Monroe, North Carolina 06/2004---07/2008

• Interviewed 60 applicants applying for public assistance weekly; processed high volume of cases.

• Contacted applicants by letter notifying them of federal and state guidelines used to reach decision on their case.

• Contact financial institutions, insurance agencies, medical providers, members of the legal community, etc. to determine eligibility in public assistance programs.

• Verify patient benefits through outbound calls and verification of insurance forms to providers of services.

• Review information to identifying any inconsistencies in coverage of benefits.

• Accurately determine coverage for primary, secondary and any other insurance benefits.

• Verify citizenship status. Review and apply HIPPA laws concerning medical records; determine level of disability.

• Participated in hearings by representing the state of North Carolina.

Education

Kaplan University, A.S. Degree, Paralegal Studies GPA: 3.27/4.0

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