Customer Service Representative
Resume:
Amy favors
********@***.***
Dallas, Tx *****
Professional Summary
Experienced customer service representative with over 5 years in the health insurance industry, adept at resolving customer inquiries, processing claims, and ensuring a high level of customer satisfaction. I seek to leverage my communication, problem-solving, and client relations expertise to contribute to United Healthcare's success and enhance customer service.
Work Experience
State Farm May 2024 – Current
Underwriter Assistant
Engage with customers to identify and address adverse situations
Assisted underwriters in evaluating insurance applications and determining coverage
Reviewed and verified information on insurance applications and supporting documents
Prepared and processed insurance policies, endorsements, and cancellations
Communicated with agents, brokers, and clients to gather necessary information and clarify details
Entered and updated data in the underwriting system, ensuring accuracy and compliance with company standards
Assisted in analyzing risks and assessing the eligibility of applicants based on company guidelines
Coordinated with various departments to resolve issues and facilitate the underwriting process
Maintained organized records and files for all underwriting activities
Played a key role in a project that improved data accuracy in the underwriting system, reducing errors
Ability to analyze data and assess risks accurately
GPS Haven December 2023 – April 2024
Junior Business Analyst
Led cross-functional teams to gather and analyze business requirements for GPS tracking software applications,
Collaborate with software development teams to define user stories, prioritize features, and ensure alignment with customer needs and goals.
Present findings and provide recommendations through clear, concise reports and presentations while adapting the Agile methodology.
Analyze GPS data to identify opportunities for process improvements and cost reduction.
Gather requirements from all relevant stakeholders and translate such requirements into business solutions for end users and stakeholders,
Requirement documentation to ensure that products, services, and solutions meet the needs and expectations of customers, which leads to high levels of satisfaction,
Stakeholder engagement for requirement elicitation and documentation
Data mapping for effective system implementation and functionality
Ensure the availability of the system application for continuous relevance.
Requirement translation through data modeling for system application improvement
Department of Human Services September 2022 - August 2023
Customer Service Representative
Answer calls from customers, providers, and potential or current members
Provide accurate and timely information to customers
Handled customer inquiries regarding health insurance policies, claims, and benefits
Educated customers on policy details and coverage options
Processed claims and maintained accurate records using CRM software
Collaborated with team members to improve service processes and policies
Adhere to time management and multitasking while using software and data entry tools
Excellent communication and interpersonal skills
Complete research and investigative activities to address customer inquiries
Answer inbound calls while providing a high-quality caller experience
Assist callers when a referral is needed or being processed
Provide insurance breakdown and explain plan information as requested
Send an email or mail correspondence when necessary to customers
Process all work-related responsibilities in an efficient, timely, and accurate manner
Addus HomeCare Corporation March 2018 - August 2022
Reauthorization Specialist
Responsible for all billing and revenue cycle management through insurance benefit investigation
Process new referrals, assignment of collections with various payers, authorization requests, and claims submission.
Accurately interprets patient insurance, prescription, and other health-related documentation.
Conducts medical insurance verifications and investigations for commercial and government payers.
Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement.
Follows all Medicare, Medicaid, and HIPAA regulations and requirements.
Abides by all regulations, policies, procedures, and standards. Performs other duties as assigned
Lash Group October 2015-February 2018
Benefit Verification Specialist
Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage
Use J-Codes, diagnosis codes, route of administration, and place of service
Process IPA claims, Medicare B & D billing, Major Medical, and PBM.
Verify patient insurance coverage to ensure necessary procedures are covered
. Accurately entering data, updating patient benefit information
Verify patient insurance via phone or website.
Obtain pre-certifications as needed.
Document all information in the computer system.
Education
GED- Boone-Winnebago County Regional Office of Education – Loves Park IL
Medical Assistant Diploma- PCI Health Training Center – Richardson Tx
Associate of Arts Degree- Collin Community College- Frisco Tx
Reference
Available on request
Contact this candidate