Customer Service Representative

AM Anna McCormick

Alabaster, Alabama ***** 205-***-****

****************@*****.***

PROFESSIONAL

SUMMARY

Friendly insurance professional experienced in investigating and processing insurance claims. Hardworking and communicative individual excels at interpreting policies and negotiating payment solutions. Recognized for providing optimum service to policyholders and quickly identifying fraudulent claims. SKILLS Insurance Coverage Limits

Documentation Reviewed

Policy Requirements and

Eligibility

Project Requirements

Insurance Industry Experience

Electronics Knowledgeable

Great Mathematical Skills

Premium Calculations

Complex Coverage Issues

Microsoft Office/word and Excel

Insurance Terminology

Insurance Plan Verification

Exceptional Recordkeeping

Abilities

WORK HISTORY HEALTHCARE CLAIMS SPECIALIST III 11/2011 to 10/2022 SS&C Birmingham, AL

Reviewed insurance and claims documents to verify required information and corrected what needed to be corrected on claims Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.

Checked documentation for accuracy and validity on updated systems. Maintained HIPAA confidentiality per company policies Maintained strong knowledge of basic medical terminology to better understand services and procedures

Generated, posted and attached information to claim files in AWD system Calculated adjustments, premiums and claim payments Corrected Medicare codes to properly classify Powerstepp claims Corrected claim issues MHP had through AWD

Researched claims and corrected issues per client request from AWD Evaluated source documents to locate needed information Communicated with supervisors and colleagues to process data quickly and resolve discrepancies

Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.

CUSTOMER SERVICE REPRESENTATIVE 05/2006 to 12/2008 Classroom Direct Birmingham, AL

Answered customer telephone calls promptly to avoid on-hold wait times. Offered advice and assistance to customers, paying attention to special needs or wants.

Responded to customer requests for products, services, and company information.

Clarified customer issues and determined root cause of problems to resolve product or service complaints

Investigated and resolved customer inquiries and complaints quickly Delivered prompt service to prioritize customer needs Educated customers about billing, payment processing and support policies and procedures.

Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly. Tried to keep short wait time in between calls

Managed timely and effective replacement of damaged or missing products.

Updated member information as needed per email or phone calls Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.

EDUCATION Associate Of Science Medical Insurance Billing 09/2006 Virginia College - Birmingham, Birmingham, AL

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