Service Representative Customer
Resume:
Hershel Reed
Long Beach, CA.**813
Objective
To obtain gainful employment with room for advancement and to continue to excel in higher levels of professionalism and self-improvement by remaining knowledgeable in my obligations, duties and responsibilities.
Qualifications
· Working knowledge of Medicare system and regulations
· Basic Medical terminology
· NHS operational knowledge
· Knowledge of website navigation
· Problem solving methodologies
Work History
09/2018 – Present Eligibility Representative Optumcare El Segundo, Ca. Implements and maintains eligibility and benefits implements updates eligibility data interacts with internal and external partners identifies and resolves discrepancies. 02/2014 to 03/2017 Customer Service Representative / phone reopenings Noridian healthcare solutions Fargo, ND
I responded to telephone inquiries and written correspondence. I researched and identified potential claims processing issues. Educated callers regarding the interpretation of Medicare guidelines. I have working knowledge of Medicare regulations, medical terminology, and Medicare bulletins. Phone reopenings: Corrected clerical errors and omissions, reprocessed claims at provider requests both phone and written, educated callers regarding the interpretation of Medicare/CMS guidelines and websites.
09/2007 to 12/2007 Intake Coordinator. Physicians Associates Pasadena, CA Updating and authorizing service, handling customer and provider complaints, verifying eligibility and resolving claims disputes.
06/2000 to 09/2003 Member Service Representative S.C.A.N health plan Long Beach, CA Assisted patients and providers with claim and benefit issues including health pharmacy vision and dental, researched and resolved escalated calls and claim issues., I issued overrides for pharmacies, Identified and referred patients with chronic needs to special care units and arranged transportation to medical visits for patients 09/1995 to 04/1999 Customer Service Representative Prudential health care Los Angeles, CA
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