SUMMARY OF QUALIFICATIONS
Confers with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints.
Keeps records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
Inputs benefit claim information for processing
Checks to ensure that appropriate changes are updated to resolve customers' problems
Determines charges for services requested, collect deposits or payments, or arrange for billing
Refers unresolved customer grievances to designated departments for further investigation.
Contacts customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
Resolves customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills.
Compares disputed merchandise with original requisitions and information from invoices and prepare invoices for returned goods.
Obtains and examines all relevant information to assess validity of complaints and to determine possible causes.
View and send claim to correct claim department enhancements includes claims guidelines
Maintains accurate eligibility records for individuals and/or assigned employer groups. Process all enrollments; plan changes, and disenrollment transactions aging to determine delinquent accounts, membership reconciliation issues from premium issues.
Health Net Woodland Hills, CA
Onsite: Health Net Member Services 7/2013 – present
Researching errors by comparing enrollment error reports against system information along with GROUPS names
Exceptional use of Word, Excel, PowerPoint and Outlook
Strong word processing skills
Accurate data entry and administrative skills
Responds to a high volume of incoming calls
Eligibility processing and confirmation
Verifies medical codes, completed pre-authorizations
Answers questions from members and physicians
Verifies insurance eligibility
LOB applications of medical inquiry
( PGU Unit ) Side by Side Customer Service trainer for new hirers employees
Performing basic clerical functions with proficient PC skills
Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes
Adecco Employment Agency Encino, CA
Onsite at: Quest Diagnostics: Billing Specialists A/R 2013
Well versed in Triple G, QBS and Screen 24 Billing software programs
Batched third party bills and input into the system
Pull SLI’s of the third party and send to collections
Keyed 300 – 400 third party billings daily
Sorted mail for all third party clients
Starwood Hotel Resort Lancaster, CA
Reservation / Sales Rep Call Center 07/2010 to 06/2012
Responsible answering approximately 80 calls daily inbound calls handling escalated calls and expedited requesting to front desk customer resolution. Supplied company line of products information to end caller’s request. Assisted in Customer Relationship Management training of new employees.
AIG Sun America Woodland Hills, CA
Financial Rep Call Center 01/2006 to 01/2009
Responsible handling 90 to 100 calls daily supporting customer requests for portfolio service authorization forms for director's review approval. Provided management division reports for daily, monthly, quarterly activities of service division. Notified clients about guidelines on compliance regulatory issues. Processed trades before and after New York Market Exchange make available to caller’s allocation funds breakdown of performance.
First America Warranty Van Nuys, CA
Claim Resolution Rep Call Center 04/2005 to 01/2006
Responsible for handling 80 calls daily processed customer home warranty claims, which entailed answering questions on status of various accounts problems or complaints via telephone/written correspondence. Arranged for license contractors to service homeowner’s transaction. Worked with appropriate teams to develop, recommend, and implement corrective actions to A/R system.
Medtronic / Volt Agency Northridge, CA
Medical Billing Tech Call Center 01/2002 to 04/2005
Responsible for handling 80 to 100 daily calls processed claims for Medicare/Medicaid, HMO and PPO insurance providers. Provided maintenance on patient accounts, which included reviewing, auditing, collections, researching and re-billing corrections and adjustments and verifying insurance coverage. As Technician I would troubleshoot patient concern with supplies and any devices of new order of products given general information when needed. Prepared monthly A/R reports for doctors.
R O P Palmdale, CA
Cert Computer Office 1 and 2 2002