Customer Service Insurance

Jean Downer

603-***-**** ************@*****.*** Raymond, NH

Experienced and driven customer service professional with 4+ years’ experience in claims management within the health care field.

SKILLS

Customer Service, Conflict resolution, Patient retention, Account management, Call Deescalating, Problem solving, Decision making, Training, Team Player, Call center, Attention to detail, Time management, Multitasking

PROFESSIONAL EXPERIENCE

Conifer Health Solutions Bedford, NH

Billing Specialist, Commercial Claims Resolution (February 2020 – Present)

Reviewed health insurance claim denials for possible resolution

Submit requests to providers for additional documentation to help resolve denied claims

Contact patients and insurance companies to obtain missing claim information and to collect outstanding balances

Demonstrated a strong working knowledge of the private health insurance field

Ensured timely follow up on denied and corrected claims to secure payment from Insurance

Injured Worker’s Pharmacy, IWP Andover, MA

Customer Support Specialist (August 2018-August 2019)

Facilitated the creation and fine tuning of new Customer Support Specialist role focused on providing exceptional account management to customers with special handling instructions

Increased collaboration with various departments in order to resolve account issues and improve customer service

Reviewed and fulfilled approximately 300 special handling requests on high priority customer accounts daily

Acted as a liaison between customers and various departments in order to swiftly provide solutions to high priority patients regarding any issues on their account

Communicated denials on medication services to patients ensuring an understanding of any future options available to them

Demonstrated a strong working knowledge of company workflow and services provided to customers by IWP

Injured Worker’s Pharmacy, IWP Andover, MA

Prior Authorization Coordinator (June 2016-August 2018)

Managed prior authorization requests on an average of 50+ patients daily

Made an average of 60 outbound calls to doctor’s offices, insurance carriers and employers to obtain missing or invalid patient and claim info

Educated doctor’s offices and referral sources on state formulary and/or IWP process changes or how to appeal a denied pre-authorization request

Gathered the necessary documents from doctor’s offices to submit medication pre-auth requests to carriers

Maintained all departmental policy and procedure documents to ensure compliance with federal, state and company regulations.

Successfully trained all new employees within department.

Demonstrated extensive knowledge of the worker’s comp system and a thorough understanding of how the company operates internally

Injured Worker’s Pharmacy, IWP Andover, MA

Verification Coordinator (August 2015-June 2016)

Fully verified an average of 20+ worker’s compensation claims a day using information provided by referral sources and patients upon their enrollment

Ensured all information provided by referral sources is accurate and that claims are accepted, ensuring collections for the reimbursement department

Made an average of 50 outbound calls and 15 inbound calls daily to and from insurance carrier and adjusters

Provided follow up to law firms or doctors’ offices to obtain any missing claim information

Investigated responsible insurance carriers for any “unidentified” claims using very little claim information

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