Customer Service Representative
Resume:
Diane Evans
East Taunton, MA *****
*********@*****.*** - 508-***-****
WORK EXPERIENCE
Customer Service Representative
HSA Insurance - Braintree, MA -
November 2013 to Present
Answer member questions regarding their medical and dental plans. Accounts Receivable Assistant
Athena Healthcare - Providence, RI -
April 2012 to November 2012
Maintain accurate resident census data. Contact insurance companies or access third party websites for accurate eligibility, prior authorizations, and insurance coverage. I would access CWF for Medicare benefits and available SNF Days to assist the Admissions Dept. Update Medicaid CMS system with referrals, admissions, and discharges. Maintain Resident Trust Account regarding deposits and withdrawals of personal needs money as well as personal bill payments. Made facility bank deposits and cashed petty cash checks to ensure enough funds were available for residents’ personal needs daily. Was responsible for ensuring resident's funds were available for hairdressing account. Assisted walk in family members with monthly payments or concerns of their family member. I also helped families fill out the Medicaid application for initial coverage or renewals. Filed and compiled resident’s charts. Provided support for Accounts Receivable Mgr. as requested.
Customer Service Representative
NHIC - Hingham, MA -
April 2009 to August 2011
Assist providers with questions regarding denied Medicare B claims. Assist providers with various questions on Medicare policies and procedures. Was the first Medicare B associate to man the Telephone Reopening Line to assist providers with simple claim corrections. I would assist walk- in or telephone providers when they had questions regarding 855I, B, or R applications, EFT, and Par agreement paperwork. Assisted providers with any questions they had regarding the Pecos, Higlas system, Appeals, Written Reopening’s, etc. questions or concerns. Directed providers to EDI dept. re: claim transmission problems. Connected Medicare Beneficiaries calls correct customer service line for assistance. Trained on Written Reopening’s and processed them on an as needed overtime basis.
As a Part A representative assisted providers with FISS claim questions, issues, and callbacks. I was backup assistance for Part B callers and the Part B Reopening Line as needed. Was a member of a team of associates who regularly assisted Provider Enrollment with application backlogs on an overtime basis.
Customer Service Consultant
Aetna Individual Billing and Administration - Fall River, MA - October 2007 to February 2008
Assist policyholders and their former employees with Cobra continuation insurance questions and procedures. Process enrollment forms, post monthly premium payments, request insurance carrier eligibility updates for prescription, medical, dental, and vision coverage. Serve as liaison between account managers, analysts, and claim offices on behalf of Cobra participants Customer Service Rep
Bank of America - East Providence, RI -
April 2007 to October 2007
Respond to account inquiries and maintenance requests from account holders in a fast pace heavy call environment. Direct and or escalate calls to appropriate departments. Provide product information when necessary and/or up sell bank products. Billing Coordinator
E-Practice Solutions - Raynham, MA -
February 2003 to January 2004
Electronically processed patient medical claim forms for optometrist offices Correspond with Insurance Companies, Optometrist offices, Electronic Software Company, and patients concerning medical claim information
Provide backup office support for owner when out of office. Work accounts receivables and month end reports.
Customer Service Representative
Johnson and Johnson - Raynham, MA -
June 1996 to November 2002
Respond to incoming inquiries by telephone, email, fax, or mail from sales reps, customers, international affiliates, or trade customers.
Order entry and account management for international affiliates. Provide technical product information from product library Receive and prepare bids and quotes on product lines Update customers with delivery information
EDUCATION
ASSOCIATES
BAY PATH COLLEGE - Longmeadow, MA
1981
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