Customer Service Representative
Resume:
Detroit, MI *****
Dear Human Resource Personnel:
In my current position, I deliver exceptional customer service and provide solutions for providers for their most difficult inquires. My current experience has allowed me to develop skills in all phases of customer service such as; complaint investigations, preauthorization, analyzing/identifying problem claims and the ability to lead. I have experience in creating process improvements with a result team and on my own. I have the skillfulness for problem solving. Once the opportunity is given, it will allow for me to be an essential part of producing some of the very best leadership skills, teamwork and success driven motivation within your establishment striving only for accelerated success for the company as well as the department.
The enclosed resume will summarize my background and experience in the above areas. I am highly motivated; customer focused and a team player that understands my role as a front-line contact. I am very much interested in joining your team. I look forward to an interview to discuss in detail my experience and accomplishments.
Thank you in advance for your time and consideration. Sincerely,
Telicia M. Meeks
Enc. Resume
PERSONAL OBJECTIVE
Seeking a challenging, growth-oriented, full-time position that requires strong analytical, organizational and exceptional customer service skills. CAREER DEVELOPMENT
Customer Service Representative IV Unit Leader Professional Provider/ Facility/Special Programs
Blue Cross Blue Shield of MI, Detroit, MI (September 20-Present)
• Analyze, evaluate, respond and adjudicate a resolution for the providers and peer inquires received via telephone, correspondence or in person involving a variety of claim/ benefit issues.
• Assists Provider field consultants with unusual and complex inquires, including irate calls, misquote of benefits, payments policies and procedures.
• Overseer of teams in the absence of the Team Leaders. Responsible for emergency leave of absence, taking over calls that required a Team leader and numerous other Team Leader responsibilities.
Customer Service Representative III Help Desk Professional Provider/ Facility/Special Programs
Blue Cross Blue Shield of MI, Detroit, MI (February 19-September 20)
• Analyze, evaluate, respond and adjudicate a resolution for the providers inquires received via telephone, correspondence or in person involving a variety of claim/ benefit issues.
• Assists other representatives and handle unusual and complex inquires, including irate calls.
• Coaching for CSR II’s ensuring the understanding of polices and resources when assisting providers
• Identify problem id claims and claims for pricing escalations Customer Service Representative II Written/Telephones Facility/Special Programs Blue Cross Blue Shield of MI, Detroit, MI (June 16 -February 19 )
• Analyze, evaluate, and respond to written and telephone inquires
• Adjudicate payments for claims that were processed in correctly
• Process high priority complex inquires for preauthorization
● Organize work and reference materials to meet corporate, quality and HIPPA guidelines Customer Service Representative II Written/Telephones Professional Provider Blue Cross Blue Shield of MI, Detroit, MI (May 07- June 16) 7170 Webb
Detroit, MI 48204
• Analyze, evaluate, and respond to written and telephone inquires
• Adjudicate payments for claims that were processed in correctly
• Process high priority complex inquires for preauthorization
● Organize work and reference materials to meet corporate, quality and HIPPA guidelines Customer Service Representative III Help Desk Telephones Professional Provider Blue Cross Blue Shield of MI, Detroit, MI (August 05- May 07)
• Analyze, evaluate, respond and adjudicate resolutions for the providers inquires received via telephone, correspondence or in person involving a variety of claim/ benefit issues.
• Assists other representatives and handle unusual and complex inquires, including irate calls.
• Fully trained to back-up CSR IV role
• Initiated inter-office transmittals for claims that processed incorrectly Customer Service Representative II Telephones Professional Provider Blue Cross Blue Shield of MI, Detroit, MI (October 01 –August 05)
• Analyze, evaluate, and respond to written and telephone inquires
• Adjudicate payments for claims that were processed in correctly
• Process high priority complex inquires for preauthorization
● Organize work and reference materials to meet corporate, quality and HIPPA guidelines JOB RELATED TRAINING and knowledge
• Nasco /Mos
• 3270
• Blue Square (nasco/local)
• Benefit Explainer/OLR
• MiSource
• Portico
• IKA Claims System
• Excel
• Ncompass
• NCSW
• Skype
SKILLS
• Strong communication skills
• Moral coach
• Coaching and Development
• Envolment in process improvement
ACCOMPLISHMENTS
• Employee of the Month
• Above the line cards received from upper management and peers
• N Compass work group
EDUCATION
Lawrence Tech University Lean Six Sigma Greenbelt (September 2016) Lawrence Tech University Lean Six Sigma Blackbelt (November 2016) University of Phoenix 24 credits (September 2013-December 2014) Michigan State University, Lansing, MI 24 credits (January 1995- March 1997) REFERENCES AVAILABLE UPON REQUEST
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