Customer Service Specialist

Erin M. James

**** ** ******** ***

Lee’s Summit, MO 64081

Phone – 816-***-****

Email- ****.*********@*****.***

OBJECTIVE In search of a good team with a great organization to dedicate my diverse and extensive qualifications and experiences.

KEY SKILLSETS

-Report & Document Preparation

-Medical Claims

-Excel

-Problem Solving

-Billing

-Outlook

-Demonstrates Initiatives

-Microsoft Word

-Facets

PROFESSIONAL EXPERIENCE

Forrest T Jones- Kansas City, Mo

Group Insurance Service Specialist

Actively and effectively manages benefit annual enrollment periods and the implementation of plan changes and transfers of coverage.

Proactively acts as the key “go to” person for clients when benefit plan issues arise.

Develop relationships with appropriate day to day key contacts at broker, TPA and policyholder levels

MoKan Sheet Metal Workers Welfare Fund- Kansas City, MO

Benefit and Claims Specialist, September 2017 to November 2017

Answers all calls regarding eligibility as well as provided benefits to all callers.

Use advanced knowledge of company software tools as well as relevant Federal and State regulations and/or company business rules to process member eligibility and billing related updates received electronically or via written correspondence.

Processed and Paid medical and dental claims.

Blue Cross and Blue Shield KC- Kansas City, MO

Billing and Eligibility Analyst, February 2015 to September 2017

Serve as the primary point of contact for a specified number of group/member accounts for enrollment, eligibility, billing and general account maintenance. Maintain accounts receivables tracking for assigned accounts, and properly communicate delinquency issues to management. Maintain accounts receivables tracking for assigned accounts, and properly communicate delinquency issues to management.

Closely monitors assigned work and proactively keeps management apprised of potential issues or backlogs, as well as other related concerns.

Exercises good interpersonal skills to build and maintain positive rapport with group/member account contacts

Customer Service Specialist, October 2007 to February 2015

Respond to a variety of members and their dependents, hospitals, providers, attorneys and agents.

Research the membership database and billing history to resolve membership issues.

Identifies potential problems or process gaps and resolves independently or with assistance.

Assist Claims department with processing and adjudication of simple adjustment.

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EDUCATION

Metropolitan Community Colleges

1993-1995; 2003-2004

Raytown South High School (1992)

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