Services Representative Service
Resume:
JOHN MCGINLEY
Philadelphia, PA 19152
Home# 215-***-****
Cell# 215-***-****
Email: *********@***.***
OBJECTIVE:
To obtain a challenging position within an organization providing opportunity to enhance my skills and abilities, while significantly assisting in achieving organizational goals.
EMPLOYMENT EXPERIENCE:
AETNA BETTER HEALTH
Prior Authorizations Representative
1/2016 to Present
Primary responsibility is assisting providers with the submission of prior authorization requests for medical services requiring authorization by the organization’s medical director prior to services rendered. This includes entering emergency requests with providers by telephone or those sent by fax.
Member Services Representative
1/2015 to 1/2016
Primary responsibility is assisting members and providers in resolution of issues concerning enrollment, benefits, claims and pharmacy via telephone through the QNXT, HEDIS, VOS and Peoplesafe systems. This includes providing education of the benefit contract as set forth by the county assistance office of the state of Pennsylvania.
WALNUT STREET THEATRE
Telephone Service Representative
7/2012 to 4/2013 – 12/2013 – 1/2015
Primary duties include contacting established theatre patrons via telephone to inform of upcoming shows and offer packages that can make the theatre experience more affordable.
APEX SYSTEMS
Order Entry Analyst
4/2013 to 11/2013
Position was contracted with Comcast. Duties include assisting with conversion of teleworker accounts, requesting site surveys for both BCI and Teleworker customers, and ensuring the portal time frames are updated daily. These duties were completed using the following systems: Workbench, DST, CSG, Teleworker Portal, BCI portal and Grand Slam.
INDEPENDENCE BLUE CROSS
Senior Member Services Representative
7/2007 – 6/2012
Primary responsibility is assisting customers, such as individuals, group administrators and brokers, in resolution of issues concerning enrollment, premium billing, website support, benefit coverage and medical claims via telephone. This includes advising how the members could get the maximum financial benefit from their medical contract.
P.A. DEPARTMENT OF LABOR AND INDUSTRY
Intermittent Intake Interviewer
11/2001 to 4/2007
Responsible for building unemployment claims via telephone with people seeking unemployment compensation. Duties include entering claimant and employer information into the database, advising claimants of unemployment claims and procedures and sending relevant information to unemployment examiners for the purpose of eligibility determination.
EDUCATION: COMPUTER LEARNING CENTER
Computer Science: Associate Degree
Completion Date: 8/1997
TEMPLE UNIVERSITY
BA in Business Administration
Major: Accounting
Completion Date: 12/1991
REFERENCES: Furnished Upon Request
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