Service Representative Claims Processor
Resume:
ANNETTE KEYS
Howey in the Hills, FL 34737
PHONE: 630-***-**** EMAIL: ****************@*****.***
Professional Summary
Over 22 years of professional experience in telecommunications and managed care. Recognized for problem-solving and leadership qualities. Skilled in building cross-functional partnerships, demonstrating exceptional communication skills, and executing critical thinking.
Relevant Experience
USAA
Orlando, FL
Banking Specialist
2021 to current
Assisting callers with Banking needs, such as Balances, setting up and Transferring Funds to external accounts, request updates on accounts
Assisting with opening new accounts
Liason with other Banking Departments
Plumbers Local 130
Chicago, IL
Claims Processor
2016-2021
Review and process EDI, Major Medical, and Medicare claims and adjustments.
Aid various constituents with health insurance benefits, eligibility, and claim status including educating retirees about future benefits.
Maintain ongoing communication with vendors and contractors (Hines & Assoc and PNA) to sustain productivity.
Train and mentor new recruits on enrollment processes and procedures.
Ensure fulfillment of all internal and external requirements and compliance regulations.
American Medical Association
Chicago, IL
Claims Processor II
2006-2014
Reviewed and processed medical claims for Medicare Supplement Plans.
Managed copious amounts of EDI and Error Report claims as well as processed paper claims.
Processed refunds and letters of receipt.
Liaise with departmental colleagues and external collaborators to coordinate claims and/or processes for completion.
CSI Agency
Oak Brook, IL
Medical Review Analyst
2005-2006
Reviewed medical records to determine pre-existing conditions applicability for policy holders and dependents.
Initiated investigative searches for members and/or policy holders to process pending claims.
Monitored pending claims for processing approval and notified policy holder(s).
Unicare
Chicago, IL
Senior Customer Service Representative
1999-2004
Assisted clients with claim status, benefits, and payments.
Informed policy holders of plans and policies.
Troubleshot and resolved client issues and complaints.
Assisted supervisor with special projects.
Education
Life, Health and Annuity -215
State of Florida
2021
Bachelor of Business Administration
National-Louis University, Chicago, Illinois
2007
Associate of Arts
College of DuPage, Glen Ellyn, Illinois
2005
Volunteer Service
Corporate Community Schools of America 1988-1990
Alpha Communications 1990-1995
Good Samaritan Hospital 2005-2006
Medea’s Kitchen 2006-2012
Skills
Proficient in MS Office: Microsoft Word, Excel, and PowerPoint
Advanced working knowledge of Hanstart, Basys Network, and Star Programs
References available upon request
Contact this candidate