Customer Service Data Entry

Name: WILLIAMS, CRAIG S.

Home Address: **** ********* **., ***. ***

Telephone: 469-***-****

CAREER HIGHLIGHTS

Objective: To make a positive contribution to the Healthcare Industry through gainful employment. Also, provide quality driven and responsive services to the company and customers, to help them achieve their business and financial objectives. To secure a position for a Healthcare organization, which will utilize and challenge my strengths in the areas of Claims administration and/or Customer Service.

Skills: proficient with various computer programs: Windows : Microsoft word: Excel; Internet, Microsoft Outlook and Data Entry

Education: Bill J. Priest Business Institute- Dallas, TX

WORK EXPERIENCE:

Aetna Healthcare

Title: Sr Claim Processor Start Dates: 02/09/2004 – 04/14/2023 Work Location: Arlington, TX. Manager: Alex Acevedo; Workplace Model: Office and Home-Based

Key Accomplishments: Provider Solutions Team Employee of the Month Nominated for the 2nd QTR 2009 AWEA Award Won Silver 2009 AWEA Award

Position Summary: Reviewed and adjudicated complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Acted as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems.

• Reviewed pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. • Applied medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. • Handled phone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. • Ensured all compliance requirements are satisfied and that all payments are made against company practices and procedures. • Identified and reportd possible claim overpayments, underpayments and any other irregularities. • Performed claim re-work calculations. • Distributed work assignments daily to junior staff. • Trained and mentored claim benefit specialists. Made outbound calls to obtain required information for First claim or re-considerations.

Title: Benefit Specialist Start Date: 07/08/2002

Department: CM Contracts Work Location: Arlington, TX.

Manager: DEVEAU, PAMELA Workplace: Office based

Provide timely and accurate set-up of plan benefit and structure, contracts and certificates into Aetna systems utilizing Aetna policy guidelines and in accordance with key performance measures, first claim/first call resolution to ensure accuracy and customer satisfaction.

Title: Billing Premium Consultant Start Date: 10/29/2001

Department: SW ASG GROUP INSTALLATION Work Location: Arlington, TX.

Manager: HUNTER, REGINA Workplace Model: Home based

Provide timely and accurate set-up of plan benefit and structure, contracts and certificates into Aetna systems utilizing Aetna policy guidelines and in accordance with key performance measures, first claim/first call resolution to ensure accuracy and customer satisfaction.

Title: Benefit Consultant Start Date: 07/09/2001

Department: CASE INSTALLATION HMO Work Location: Arlington, TX.

Manager: ROY, ELLEN Workplace Model: Office based.

Provide timely and accurate set-up of plan benefit and structure, contracts and certificates into Aetna systems utilizing Aetna policy guidelines and in accordance with key performance measures, first claim/first call resolution to ensure accuracy and customer satisfaction.

Title: Health Care Facilitator Start Date: 06/14/1999

Department: Patient Management Work Location: Dallas, TX. Manager: PAMELA JOBE Workplace Model: Office based

Took incoming calls from physician offices and hospitals to determine medical precertification medical needs.

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