Customer Service Quality Control

DEBORAH S. BENNING

****-* ****** **. *****, Ga **809

706(664-6763)

*******.*********@*****.***

To work in a highly competitive environment with a perfect challenge by contributing the best for the growth of the organization while ensuring growth in personal career. EXPERIENCE

JUNE 2005-PRESENT

APPEALS SPECIALIST III-PALMETTO GBA

Respond accurately and timely to incoming calls from providers, explaining claim denials and adjusting claims to allow.

Prescreen incoming correspondence to appropriate buckets in a timely manner. Re-adjudicate claims based on medical necessary, considering all documentation supplied and requested, make claims adjustments based on material evidence. Maintain the research bucket with a timely manner, by calling providers requesting additional documentation from beneficiaries requesting an appeal request. Process incoming departmental work assignments in support of appeals area. Train new associates and follow-up on their progress through quality control activities. Provides timely feedback to management for associates in order to correct any issue discovered. Distributes and assigns work to associates, develop and monitor daily reports to ensure productivity, timeliness and quality standards are being met. Assists associates with the more difficult cases and answer questions to help resolve the case. NOVEMBER 11, 1997- 2005

CUSTOMER SERVICE REPRESENTIVE

Respond accurately and timely to incoming calls from providers. Assemble files for proper content and order additional information, as needed to forward to medical for review.

Prescreen incoming correspondence to appropriate buckets in a timely manner. Re- adjudicate claims based on medical necessary, considering all documentation supplied and requested, make claims adjustments based on material evidence. Maintain the research bucket with a timely manner, by calling providers requesting additional documentation from beneficiaries requesting an appeal request. EDUCATION

JUNE 1987

High school Diploma- Harlem High School

SKILLS

Proficient in Microsoft Word, Excel, Fax Copier, Scanning REFERENCES AVAILABLE UPON REQUEST

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