Customer Service Representative
Resume:
Valarie Lovely-Selders
Profile
A highly motivated professional with over 10 years of experience as a claims adjuster, customer service representative, call center representative with retail experience. Good eye for detail; well organized, skilled in setting priorities. Ability to interact with customers, clients, and maintain confidential information. Strong team player with 3.5 years of management experience. Reputation for excellence and high-quality service to clients. I have contributed to the successful operations of various organizations by adopting the skills necessary for task completion and meeting strict deadlines within fast- paced work environments.
Areas of Expertise
Skills & Software 45 WPM Adaptable AIE/CIE/PIE Amisys Analyzer Clear verbal and written communication Collaborator Dental Empathetic Facets Subject Matter Expert Federal HMO/POS/PPO Interpersonal Leadership Legacy Medicaid/Medicare Microsoft Office Patience Problem Solver Quick Learner Self-control Self-motivated Time management Employment Narrative Dell Services/ NTT Data. Worked in the Genesis system and Unity phone system. Facets trained and abide by all HIPPA guidelines and regulations.
Professional Experience
• 3rd Shift CSR FMLA Remotely for Kepro in Absence Management 2022-2023
Process and Mark off or Mark Up an Employee for leave in multiple lines of the departments throughout the company. Those leaves ranged from intermittent to
continuous. Retrieve faxed over medical records and load them in the system for processing by the assigned due date. Close, complete and work multiple tasks in between calls. Provide accurate and kind customer service on that first call.
• Senior Claims Examiner Remotely for BCBSLA; 2020 – 2022 & 2015 - 2017 Trained employees Returned claims requesting missing information in accordance with quantity, quality and timeliness guidelines Made changes on local contracts adhering to departmental and corporate guidelines
Recalculated benefits Entered coded information Identified and resolved inconsistencies Checked claims for completeness and accuracy prior to final entry.
• Jacobson Group Claims Examiner; Temporary 2018-2019 Reviewed HCSC claims for completeness and accuracy prior to Contact Information
4087 David Road
Zachary, Louisiana 70791
ad5dba@r.postjobfree.com
Education
Capitol High School
Baton Rouge, Louisiana
General Studies
References
Danielle Jones
Blue Cross Blue Shield of La
Alexis Selders
Blue Cross Blue Shield of La
Andrea Hogan
Blue Cross Blue Shield of La
final entry Reviewed and resolved Medicaid and Medicare disputes Confirmed accuracy of appeals data received for review Utilized guidelines to determine status of appeals EA Renfroe Desk Examiner; Temporary 2017 - 2018 Handled high volume inbound calls pertaining to Hurricane Irma catastrophe Evaluated complex claims Collaborated with adjusters to collect claim information Explained and negotiated settlements with insured and representatives.
• Blue Cross Blue Shield of Louisiana; Lead Adjustment Processor 2011-2014 Trained department on new procedures and processes Set daily performance goals and identified work process solutions Reviewed, researched and adjusted ARs, memos, recons, financial investigations and MSPs Utilized the medical configurator to ensure claims were accurately priced by DRG Processed local contract coverage changes Priced DME Recalculated benefits of claims with incorrect codes or processed incorrectly Adjustment Processor & Special Claims Processor.
• Adjustment Processor & Special Claims Processor 2006-2011 Entered coded information Returned claims requesting missing information in accordance with quantity, quality and timeliness guidelines Identified and resolved inconsistencies Reviewed claims for completeness and accuracy prior to final entry Recalculated benefits of claims with incorrect codes or processing for hospital, professional, major medical, Medicare and dental.
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