Claims Processor Service Representative
Resume:
Syracuse, UT *****
Phone: 317-***-****
Email: adur98@r.postjobfree.com
Availability: Immediate
Job Type: Permanent
Work Schedule: Full Time
Military Spouse Preference: Yes
Security Clearance: Eligible
PROFESSIONAL EXPERIENCE:
Smith’s Pharmacy
Syracuse, UT
September 2016 – Present
Pharmacy Technician
Hours Per Week: 16-28
Salary: $38,000 per year
Supervisor: Stephanie Smith
Phone: 801-***-****
May Contact: Yes
Prepares labels, pulls product, and fills prescriptions accurately and in an efficient manner
Accuracy scans on all labels and vials to ensure the correct medication is dispensed to the correct patient
Consistently praised for efficient handling of customer service duties (e.g., answering phones, typing prescriptions, patient processing and billing) that allowed Pharmacists and pharmacy staff to focus on the health concerns of their patients
Ensured the cleanliness, sanitation and maintenance of all facilities, pharmacy and equipment
Helped implement pharmacy's quality assurance and control program. Efforts ensured compliance with HIPAA, State Board of Pharmacy and OSHA regulations; and improved patient care/satisfaction
Reacts calmly and effectively in emergency situations, and added the personal, caring touch that immediately put patients at ease
Streamlines data management procedures by reducing the number of categorical inputs
Maintains a 5-step checkpoint list to ensure the accuracy of directions
Provides excellent customer service in person and on the phone
Communicated in an effective and friendly manner by telephone, e-mail, and messenger services with clients, vendors, and management
Multi-tasks by answering phones while typing prescriptions and filling medications
Utilizes various types of office equipment on a daily basis to include copier/scanner/fax, multi-line phone system, desktop and laptop computers
Updates inventory and observes strict storage requirements
Ensures all medications are within effective dates
Utilizes several computer databases on a daily basis
Maintains several spreadsheets and expert level use of all Microsoft Office products to include; Word, Excel, PowerPoint
Med-1 Solutions and Complete Billing Services
July 2007 – August 2009
Worker’s Compensation Specialist
Hours Per Week: 40
Salary: $40,000 per year
Supervisor: Jennifer D. Meyer
Phone: 317-***-****
May Contact: Yes
Managed patient hospital billing accounts, specifically patients who were injured due to a Workers Comp Injury.
Worked as a paralegal hand in hand with Jennifer Meyer to prepare documents for court and file them with the State.
Actively managed over 180 open workers compensation claims, including directing medical treatment and distributing compensation benefits.
Successfully conducted quarterly claims reviews with all clients to keep them abreast of their open claims and claim strategies.
Maintained high level of confidentiality in handling clients' medical claims, including knowledge of HIPPA.
Compiled all incoming and legal documentation to determine basic eligibility for benefits or programs.
Attempted to collect the owed balance from the Employer’s responsible for the bill.
When payment was not received, I opened claims with the Indiana State Court to seek payment.
Worked as a paralegal hand in hand with Jennifer Meyer to prepare documents for court and file them with the State.
Communicated in an effective and friendly manner by telephone, e-mail, and messenger services with clients, vendors, and management
Maintained several spreadsheets and expert level use of all Microsoft Office products to include; Word, Excel, PowerPoint
Utilized various types of office equipment on a daily basis to include copier/scanner/fax, multi-line phone system, desktop and laptop computers
Mutual Eye Claim Audits
REMOTE
August 2005 – July 2007
Remote Claims Processor
Hours Per Week: 40
Salary: $38,500 per year
Supervisor: Deb Ingmire
Phone: Deceased
May Contact: N/A
Provided independent decision making skills and demonstrated initiatives to resolve issues for internal and external customers
Answered incoming calls and conducted interviews with both patients and insurance companies to gather and clarify information
Composed and typed routine letters and documented file activity on a regular basis on the computer
Processed and handled new non -claims
Performed clerical functions which included opening, sorting and distributing incoming mail and processing outgoing mail, copy work, handled office subpoenas, filing and assisted the unit and supervisor in multiple projects using expert time management with little supervision
Paid vendor statements and handled payment complaints and discrepancies
Processed checks, stop payments, cancellations, voids and journal entry payments
Communicated in an effective and friendly manner by telephone, e-mail, and messenger services with clients, vendors, and management
Maintained several spreadsheets and expert level use of all Microsoft Office products to include; Word, Excel, PowerPoint
Utilized various types of office equipment on a daily basis to include copier/scanner/fax, multi-line phone system, desktop and laptop computers
Mutual Eye Claim Audits
April 1999– April 2002
Customer Service and Claims Processor
Hours Per Week: 40
Salary: $35,000 per year
Supervisor: Deb Ingmire
Phone: Deceased
May Contact: N/A
Answered busy phone lines verifying patient eligibility by conducting interview with clients and annotating all answers in database
Communicated with Dental, Optometrist and Ophthalmologist offices, for claim verification
Communicated in an effective and friendly manner by telephone, e-mail, and messenger services with clients, vendors, and management
Proofread contracts with potential clients to obtain new contracts.
Processed Dental and Visions Claims
Printed checks and mailed them.
Client relations; Packaged incentives and gifts for current and potential Employer groups.
Considered appeals for claims unpaid and problem resolution.
Performed medical billing and adjustments for claims.
Assisted members, physicians and hospitals with queries and concerns on accounts.
Navigated through various databases and programs for updating and maintenance daily.
Daily follow-up on claims and correspondence.
Provided information to members on various benefit insurance packages offered.
Provided ICD-9 and diagnostic codes for claims and medical procedures.
Maintained, correlated and prepared medical records and files of members.
Maintained several spreadsheets and expert level use of all Microsoft Office products to include; Word, Excel, PowerPoint
Utilized various types of office equipment on a daily basis to include copier/scanner/fax, multi-line phone system, desktop and laptop computers
There are several gaps in my resume due to my time as an active duty military spouse while raising children and supporting my husband in his active duty military career
EDUCATION:
PHARMACY TECHNICIAN’S UNIVERSITY
State of Utah Certified Pharmacy Technician – July 2017-Current
BYU IDAHO
Working toward Associate in Science (A.S.)– Sep 2017-present
Attending part-time. Anticipated graduation date May 2025.
BON LOSEE ACADEMY OF HAIR ARTISTRY
State of Utah Certified Cosmetology License – Nov 1996-Current
PROFESSIONAL REFERENCES:
Ms. Veronica Humphrey
Veteran’s Service Representative, SLC VA, SLC, Utah
Mr. Andrew P. Bingham
Chief of Staff, DLA Aviation at Hill AFB, Utah
adur98@r.postjobfree.com; 801-***-****
Mr. John DeCaprio
Program Manager, United States Air Force, Hill AFB, Utah
Contact this candidate