Center Associate Agent Service
Resume:
Folkston GA *****
***********@*****.***
Morvydd Norton
Objective
To obtain knowledge and experience in the working environment
Experience
**/**/**** – present. Cigna Healthcare
Customer Service Representative
Handle incoming Medicare advantage customer calls for benefit, RX questions
Update members records for accurate address, phone numbers
Research guidelines to assist members.
01/31/2022 – 6/28/2022. AmeriHealth Caritas
Claims Examiner
Accurate processing of medical claims via electronic system.
Following processing and procedures to adjudicate claims for payment.
Inputting other carriers payment for coordination of benefits.
08/28/2016- 9/28/2021 Florida Blue
Agent Service Center Associate
Act as an advocate and account liaison for supporting Florida Blue’s internal and external sales agents via inbound telephone service
Research and resolve all inquiries both sales related and service related for all lines of business
Maintain timely follow-up with internal and external agents
Network and interact with numerous operating areas throughout the company to research information and implement solutions for sales partners whose needs demand agility and persistence.
02/22/2016-8/28/2016 BCBS of Tennessee
BlueCard Claims Processor
Research and adjudicate claims for the Host plan
Coordinate benefits with primary insurance.
Working claim holds and edits
07/22/13 02/22/2016 Florida Blue
Agent Service Center Associate
Act as an advocate and account liaison for supporting Florida Blue’s internal and external sales agents via inbound telephone service
Research and resolve all inquiries both sales related and service related for all lines of business
Maintain timely follow-up with internal and external agents
Network and interact with numerous operating areas throughout the company to research information and implement solutions for sales partners whose needs demand agility and persistence.
08/06/2011- 07/19/13 Florida Blue, Blue Cross Blue Shield Florida
Benefit Specialist Care Consultant Program
Providing second to none care focused service resulting in cost, quality effective healthcare choices
Taking on a consultative approach and focus on empowering our member to successfully navigate through complex healthcare systems
Promoting self-service tools to our members
Promoting medical cost savings, quality care options, and preventive health measures and building member alliance.
Enhanced member experience, providing member educating of tools that will enhance the members experience via my blue service, pharmacy shopping tools, benefit explanation
Promoting cost savings, ex: Diagnostic centers vs. Hospitals
6/2/2003-08/22/2011 Blue Cross Blue Shield Florida
Service Associate Federal Employee Program
Document Federal Employee calls from members and providers
Interpret data utilizing analytical skills
Accurate attention to quality
Assist fellow team members and management with pending files to meet inventory goals
Subject matter expert for team members and Diamond Trainees
Member of GEM team to boost employee moral
11/1/04-7/24/06 First Coast Service Option of Florida
Service Associate
Document Calls for Medicare Part B providers
Claim processing problem solving
Telephone claim reviews
Assist appeals area in inventory control
Assist providers with education on billing and web use
Assist management with new trainees and inventory control
05/2002-6/3/2003 Mayo Clinic Florida
Patient Financial Specialist
Problem solving ability utilizing analytical skills to process and interpret data from multiple sources
Document calls from patients concerning treatment and billing issues.
Participate in a team environment and contribute input to the efficiency of the area
06/1995 – 05/1999 Blue Cross Blue Shield of Florida
Quality Auditor, Claims Examiner
Implemented procedures into written format for training purposes as well as guidelines for claims representative
Organized training meetings and training manuals
Provided claims processing unit with policy updates and training issues.
Processed individual and group policy claims
Assist with training of new employees
Accurate claims entry of PPO local, Medicare and More HMO claims and working all hold codes and investigational edits
06/99 – 10/00 Cigna Health Insurance Chattanooga, TN
Claims Examiner
Administered third party insurance claims.
Processed 250+ medical and dental claims on a daily basis via image entry.
Processed secondary payer claims.
Education
1989 Edward H. White High School Jacksonville, FL
Training
Microsoft Word, Excel, Power Point, HCPCS, ICD 9, CPT coding and Medical Terminology Training. Legacy systems, Convergence, Client Letter, CMCA, Claims Repository, FEP Direct, Diamond, Automated Pricing Tool, MHS Claims system, Provider Information Platform, CCT help files, My Blue Service, Web MD, Health Dialog, Online Provider Directory, Care Comparison Tool, Care Calculator, Prime Therapeutics, Member 360 Tools, CCT Website, Siebel
Contact this candidate