Customer Service Office Manager

DIANE BECTON

Hammond, IN ***** 219-***-**** ad00zo@r.postjobfree.com

Objective

Motivated, dependable, hardworking, individual seeking an office manager position. Enthusiast with strong interpersonal skills and strengths in customer service and problem solving.

Education

Catherine College November 1992

Business Administration Certificate

South Shore High School June 1984

Diploma

Skill Qualifications

Expertise; with Microsoft Office and Internet Applications

Adept with organization; deadline sensitive when scheduling and prioritizing tasks

Successful at responding to challenges; solid planning and problem-solving skills

Active self-starter; consistently complete multiple projects independently; excellent in multitasking

Strong team builder and leader; enjoys the challenge of taking projects from concept through to completion

Detailed experience in program and project management; flexible with work schedule

Employment Experience

Integrated Specialist April 2012 -Present

Humana Chicago, IL

●Customer Care Specialist for customer support to directly respond to questions, handle issues and provide guidance to both internal and external customers.

●Facilitate follow-up communications with insurance companies and patients regarding claim/payment status through practice management system and reporting tools.

●Receive, document and resolve customer inquiries by using established best practices

●Build lasting relationships with internal and external customers.

●Document all actions and maintain a permanent record of patient accounts to ensure a sufficient audit trail.

●Educate providers and employees about benefits, claims, pharmacy, etc., and services face to face and over the telephone eligibility, and authorization inquiries.

Customer Service Representative October 2009 - December 2011

Anthem BCBS Indianapolis, IN

●Answered incoming calls into call center and assist patients/insurance companies with account questions in a courteous and timely manner. Ensure patient/insurance companies understand the billing statements and processes to provide the highest level of customer care.

●Identified system issues that result in failure to provide appropriate care to members or failure to meet service expectations.

●Ensured compliance with state and federal regulations as they relate to appeal and grievance issues.

●Research and obtain necessary documentation for insurance companies to process outstanding claims.

●Identified denials and appeal with proper documentation within a timely manner to secure payment.

●Answered patients' questions regarding statements and insurance coverage. Telephones or writes companies with unpaid insurance claims to obtain settlement of claim.

Appeals and Grievance Coordinator March 2005 - September 2009

Molina Healthcare, Inc. Merrillville, IN

●Conduct investigation and review of member grievances and appeals involving provision of service and benefit coverage issues.

●Complied with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

●Summarize cases including articulation of member’s perception and present essential information for review.

●Generated written correspondence to members, providers and regulatory agencies.

●Ensure appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory agencies or member needs.

●Thoroughly document the investigation and resolution of each case.

Marketing Specialist April 2004 - March 2005

AmeriGroup of Illinois Chicago, IL

●Ensure timely communication with the Manager on all issues having potential risk and or impact on operations.

●Handled escalated member and provider concerns with the dual goal of ensuring satisfaction and retention.

●Contacted customers to gather information and communicate disposition of the case and documents interactions.

●Identified, qualified and educated possible enrollees on the AmeriGroup Managed Care Plan.

●Documents daily and weekly sales reports with the required timeframe while assisting manager with marketing locations.

●Serve as the liaison with other departments to resolve grievance issues.

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