Customer Service Claims Specialist
Resume:
ETRINIDY PHILLIPS
Tampa, FL *****
**********************@*****.***
Professional Summary
Administrative/Clerical/Customer Service Dynamic and performance-driven administrative professional with strong organizational, customer service, and communication skills. Multi-disciplinary industry expertise with emphasis in records management, medical claim processor and receivable. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level [Job Title] position. Ready to help team achieve company goals. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Skills
Automobile claims specialist
Advanced facials specialist
Records management specialist
Claims reporting systems
Claims assessments
[Specialization] care specialist
Inputting claims
Processing medical claims
Advanced [Specialization] specialist
Intuit QuickBooks specialist
Work History
June 2020 - February 2022
Zenith CLAIMS SPECIALIST
Analyzes and approves routine claims that cannot be auto adjudicated
Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process
Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues
Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements
In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor).
January 2020 - June 2020
University of Tampa
CLAIMS ADMINISTRATIVE SUPPORT
Performs general clerical duties to include but not limited to: photocopying, faxing, mail distribution and filing
Accurately established and maintained all customer documents
Coordinates and maintains records for staff office space, phones, company Handled outgoing/incoming shipments
of files; sorted/routed incoming and outgoing mail to proper servers in a timely manner
Ensuring that deadline are met and work is completed correctly
Implement and monitor programs as directed by management
Generate memos, emails and reports when appropriate.
February 2019 - December 2019
Busch Garden
Crew Member
Performs housekeeping duties to keep the facility and equipment clean and inviting
Participates actively with other crew members and managers to meet sales target during your shift
Ensures to greet all customers with a smile
Ensures fast and timely food service to guests
February 2020 - January 2021
One touch direct - 2124 Sligh ave
Customer Service Representative
Updated account information to maintain customer records.
Answered constant flow of customer calls with minimal wait times.
Responded to customer requests for products, services, and company information.
Provided primary customer support to internal and external customers.
Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Answered customer telephone calls promptly to avoid on-hold wait times.
Education
Zephyrhills High School
High School Diploma
Expected in March 2025
Hillsborough Community College 2756 Ybor city
Associate Public Health
Professional development completed in [Subject]
Awarded [Award Name]
Continuing education in [Subject]
Completed professional development in [Subject]
Elected to [Elected Position] for [Student Organization, Fraternity or Sorority] in [Year]
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