Service Representative Call Center

Daniel B. McFarlin

Professional Experience

United Healthcare 2014- Current

Call Center Supervisor Dental/Vision (San Antonio, TX)

Developed and managed projects involving 1:1 Readiness planning and reporting, Specific State Medicaid peer to peer monitor/reporting, State of Kansas Medicaid Quality audits/performance reporting.

Developed and managed Specialty Benefits “Pulse Watch” to ensure efficiency and effectiveness in-line with departmental 1:1 readiness.

Coordinates, supervises and is accountable for the daily/weekly/monthly activities of team members.

Sets priorities for the team to ensure task completion and performance goals are met as well as provides coaching and feedback to team members, including formal corrective action when necessary

Coordinates work activities with other supervisors, managers, and departments.

Identifies and resolves operational problems using defined processes, expertise, and judgment

Conducts annual performance reviews for team members

Provides expertise and customer service support to members, customers, and/or providers

Strong proficiency for performing multiple software functions

United Healthcare Dental/Vision – San Antonio, TX 2011-2014

Service Account Manager Associate

Managed Southeast region of the United States which included Florida, North Carolina, South Carolina, Georgia, Alabama, Mississippi, Arkansas, Louisiana and Texas by handling all aspects of Dental and Vision claims matters from Group administration, claims processing, Member and provider appeals and grievances

Planned and created development processes as well as provider utilization assessments

Developed and maintain Microsoft access database of all incoming member, provider concerns, complaints, and supervisor coaching opportunities for the onshore and offshore sites

Organize/maintain and processing of Dental escheatment along with over-rides and check reissues.

United Healthcare Dental/Vision – San Antonio, TX 2007-2011

Senior Customer Service Claim Processor/ Eligibility Call Back Lead/ SST Unit assistant/ Training Unit assistant/ Certified Mentor

Provide benefits and eligibility for members and providers

Answer inquiries regarding member claims, process, procedures, and benefit coverage

Resolve concerns regarding dental claims, payments, and procedure code to include CDT codes.

Knowledge of Dental health insurance terminology.

Strong background in high volume call center environment.

Served as a Team Leader.

Coordinated and lead the Eligibility Call Back Team in responding to member, provider, and broker eligibility concerns

McFarlin Plumbing LLC – San Antonio, TX 2007-2011

Owner

Managed and supervised all aspects of a small business with over 15+ employees and contractors to include administration of employee files, payroll, and enforced company policies and procedures.

Over 5 years of business management experience.

PacifiCare (United Healthcare) – San Antonio, TX 2004-2006

Medical Customer Service Representative

Provided benefits, eligibility, and authorization for members and providers for Medical / Vision / Dental Plans.

Resolved issues regarding medical claims, payments, and procedure code to include CPT and ICD9 codes.

Answered inquiries regarding member eligibility, claim processing procedures and benefit coverage.

Examined medical, dental, and vision claims for errors and referred for claims reconsideration.

Knowledge of health insurance terminology, CPT, ICD9, ADA.

Familiar with provider contractual agreements PPO’s, POS’s, and EPO’s.

Knowledge of HIPAA (Health Insurance Portability and Accountability Act of 1996).

RMH Teleservices (Client UPS) – San Antonio, TX 2001-2004

Mentor & Learning Lab Trainer/ UPS International Customer Service Representative / UPS Universal Tracking Agent

Managed/lead in the training of new employees in the learning lab (training room) prior to their transition to the main call center floor.

Assisted Management in the Mentoring and Training Program for both International and Domestic Agents

Perform periodic remote call monitoring and testing of agents on the company’s quality expectations and coached employees on the proper problem resolution processes and company procedures.

Provided internal audit reports and many other responsibilities that would allow smooth operation of the department.

Handled escalation issues when supervising.

Resolved problem issues for customers who received damaged packages, were unsatisfied with services, and had documentation issues, to include NAFTA Certificate of Origin, Shippers Export Declaration, Letter of instruction, and Power of Attorneys, as well as any other shipping set back that would arise.

Assist customers with inquiries on international shipments.

Respond to customer’s request for a supervisor when necessary

Assisted inbound customer inquiries on tracking packages to and from the origin and destination location.

Process and file guaranteed service refunds and damaged inspection claim reports on behalf of the shipper.

Scheduled package shipments and calculated hundredweight rates on multi packages to multi-destinations.

Processed delivery change request for customer to allow for proper and timely delivery.

Benefit Planners LTD – Boerne, TX 1998-2001

Medical Claims Analyst/Customer Service Representative

Solved problems regarding medical claims, medical payments, and procedure code to include CPT codes and ICD9 codes.

Strong background in high production environments.

Answer inquiries regarding member eligibility, claims processing procedures and benefit coverage.

Examined medical, dental, and vision claims for errors and referred for claims reconsideration.

Heart & Vascular Institute of Texas – San Antonio, TX 1993-1998

Eligibility Coordinator/ Medical Records Supervisor/ Clerk

Directed team members in the verification of benefit coverage information of patients to insure accurate and timely claims processing

Resolved issues that would arise in claims process.

Assisted the billing department in claims filing and claims appeals process

Preformed required audits on patients account to insure proper information retention

Supervised seven records clerks in maintaining medical files on patients.

Resolved issues with obtaining medical information release.

Corresponded with outside providers of service to provide medical information on patients according to proper company’s guidelines.

Organized and implemented guidelines to distribute/maintain accurate information to physicians and other providers of service.

Education

Theodore Roosevelt High School – High School Diploma – Completed 1983

Training Seminars

Skill Path Management Training

Records and Filing System Management

Petty Officer Leadership Training

Power Plant and Related Systems Specialist Training

Small Business Development Association Courses

Influencing without Authority

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