Faith Luben

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

Columbus, Georgia *1903

Cell: 762-***-****

Email: ad354z@r.postjobfree.com

CAREER SUMMARY:

-Over 10 years of excellent customer service skills and a keen ability for detail.

-Fast learner and able to perform duties without immediate supervision.

-Performs multitasking with ease.

-A team player with intentions on helping a company attain goals.

EXPERIENCE:

Delta Dental, Remote

Jan 2021- Jan 2022

Claims Processor

●Reviews Daily Inventory to determine workflow to maintain department turnaround time expectations.

●Receives and works queue inventory through the processing system.

●Research claims / pre-treatment estimates for supporting documentation including eligibility, applicable benefits, processing policies and coordination of benefits.

●Initiates manual requests for required supporting documentation.

●Researches, resolves and processes appeals, checks and paper workflow in folders to maintain the inventory levels according to department goals.

●Identify procedures requiring review and refer to appropriate consultant with all required documentation. Maintain tracking, decision and claim resolution of the referral within the system.

●Working knowledge of benefit coverage, processing policies, products and provider networks provided by DDCO.

●Responsible for maintaining and ensuring all procedures in the operations department follow HIPAA standards and regulations.

Maximus, Remote

May 2019- Nov 2020

Validator (Legal Assistant ll)

●Analyzing claim information to determine the cause of outstanding issues

●Assessing eligibility requirements based on UI Code, Policies and Procedures

●Evaluating wage and earnings

●Communicating with claimants and employers by phone to obtain missing information

●Notating all contacts and actions taken on a claim clearly and thoroughly

●Demonstrating the ability to make timeline and logical decisions

Anthem, Columbus, Georgia

Jan 2017- April 2019

CSR

●Codes and processes claim forms for payment ensuring all information is supplied before eligible payments are made.

●Reviews, analyzes and processes claims/policies related to events to determine extent of company’s liability and entitlement. Researches and analyzes claims issues. Responds to inquiries, may involve customer/client contact.

●Use a PC, database system, and related software (word processing, spreadsheets, etc.).

TSYS, Columbus, GA

Oct 2015- Jan 2017

Customer Service Representative

●Receives and/or places telephone calls which are predominantly routine, but may require deviation from standard screens, scripts, and procedures.

●Answer customer telephone inquiries, orders, service needs and complaints, respond where applicable or direct to technical/service areas. Maintain detailed and current knowledge of the company's/assigned client's products and services.

●Analyze customer service needs for communication to service and technical departments, when applicable. Requires ability to navigate a computerized data entry system or other relevant applications.

EDUCATION:

HS Diploma

REFERENCE:

Available upon request

Contact this candidate