Customer Service Representative
Resume:
Anisa Jones
‘******@***.***
PROFESSIONAL SUMMARY.
Business Professional with over 10 years of experience in customer service in a healthcare setting
Previous tenure while working within the healthcare industry working for CVS Health and Cigna; extremely
knowledgeable in Medicare/Medicaid
Known to create and represent an excellent image of the company and its service to customers
Possesses passion to work in customer service and the capability to work within a team; reliable, punctual and
professional .
Exceptional communications skills; professional phone and in-person presentation
PROFESSIONAL EXPERIENCE
CVS Health
Customer Service - Benefits Verification
‘August 2010 — Present
Cigna
Maintain a high-volume workload within a fast paced environment; 100+ inbound calls daily
Receives, processes, and verifies the accuracy of customers! requests and confirmations via email
Gather patient's information during new enrollments
Verify route callers accurately when needed that all callers are within compliance with HIPPA and corporate
regulations
Verifying insurance coverage, benefits, and obtaining pre-certification, referral or authorization as needed per
insurance company requirements
Knowledge with prior authorizations and cash posting Able to read and interpret EOB's
Updating insurance information into patients’ profile
Check CPT and ICD9/ICD10 codes
Customer Service Representative
March 2002 — July 2010
Responded to inquiries on client’s insurance claims/polices
© Performed research to inquiries and interpret policy provisions
‘* Routed claim forms and supporting documents for final processing
+ Verified patients’ insurance eligibility and collected patient responsibilty payments
‘* Notified patients, family members, physicians and/or supervisors of network insurance coverage issues that may
result in coverage reduction :
* Notified patients of co-payments, deductibles or deposits needed, when applicable, documenting all information
in computer system :
EDUCATION
linois Pharmacy Technician
Clinical Licenses
Moraine Valley Community College
Business Administration
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