Chicoria Parker

***** ****** ****** ****

Blvd. apt 2603

adx8yj@r.postjobfree.com

+1-832-***-****

Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Claims Experience Specialist Customer Care (CallCenter) Aetna, a CVS Health Company - Houston, TXMarch 2019 to March 2022 Analyzes and approves routine claims that cannot be auto adjudicated. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. Mail Handler

United States Postal Service - Houston, TX

September 2018 to February 2019

Seasonal Delivers letters, documents, and parcels to businesses and homes. Travels planned routes on foot and by truck.

Claims Analyst Customer Care (Call Center)

Amerigroup/Anthem - Houston, TX

November 2015 to January 2017

Worked from home-Researched and processed all intermediate level claims transactions. Processing includes most claim types with the exception of inpatient, transplant, dialysis and hospice Processed correspondence and customer service inquiries as it relates to the above claims transactions Processed primary care encounter information and fee for service claims received in both paper and automated formats into claims systems Accurately interpreted, understands and applied product contracts and fee schedules for assigned markets when processing claims Interpreted and applied explanation of benefits (EOB) statements from other carrier to facilitate coordination of coverage Reviewed and responded to quality audits Responded timely to quality error assignments and provide appropriate documentation to support actions Performed other duties as assigned. Precisely completed appropriate claims paperwork, documentation and system entry. Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.

Accurately posted and sent out all medical claims. Identified and resolved patient billing and payment issues. Confidently and adeptly handled claim denials and/or appeals. Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable. United Healthcare Advocate/ Call Center

Provider Resolution Specialist - Sugar Land, TX

March 2014 to October 2015

Responsibilities

Answer incoming phone calls from health care providers (i.e. physician offices, clinics) and identify the type of assistance the provider needs (i.e. benefit and eligibility, billing and payments, claims, authorizations for treatment and explanation of benefits (EOBs) Focus on resolving issues on the first call, navigate through the appropriate computer systems to identify the current status of the issue and provide appropriate response to caller Deliver all information and questions in a positive, conversational and compassionate manner to facilitate developing a relationship with the provider, while providing the best customer service experience possible

Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends

Meet the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance Skills Used

HIPPA QUALIFIED! Navigating through 5-8 systems at one time, servicing 50-70 calls in a 8hr shift. Maintaining and meeting all Stats at a 100% quality every month. In the month of Aug recognized as Top Performer by the CEO of the company!

National Customer Care Associate (Call Center)

Kelly Services- Amerigroup Healthcare - Houston, TX December 2013 to March 2014

Responsibilities

Accepting inbound calls from Providers and Members assisting with changing pcp's,locating doctor offices,verifying eligibility and benefits for both members and providers. While experience very HIGH call volume, and maintain 99% monthly quality score.Faxing documentation to providers in other state solving members issues.

Accomplishments

HIPPA QUALIFIED!

Good listener with effective customer communication skills Cooperative and enjoy working with others as part of a team Able to multi task while maintaining integrity and quality of service Above average computer navigation skills

Skills Used

Microsoft Excel, Word, and Outlook

Customer Service Associate/Call Center

xerox - Houston, TX

November 2010 to April 2013

Responsibilities

Accepting inbound phone calls, by activating services such as, cell phones and internet services. Accepting bill payments, up selling products, and adding extra services to accounts. Answered any questions that customers may have processed refunds and credits, while maintain a 100% Issue Resolution Quality for 1 year straight! Also assisted my supervisor by taking on team lead by taking escalated calls and assisted many other supervisors’ agents by Floor Walking. Skills Used

Experienced in providing direct customer support by answering inbound calls and providing in-person customer service. Solid customer satisfaction and account-management skills that results in increased revenue and longstanding customer relationships.

Customer Service Associate/Call Center

Barnett staffing Chase Bank - Houston, TX

January 2008 to October 2010

Responsibilities

Serviced customers, including processing and disbursing loans; opening, closing, and reconciling accounts;

Processing payroll deductions and direct-deposit requests; processing modifications to existing accounts; And marketing additional banking services and products to customers. Customer Service Representative (Call Center )

Barnett staffing IRT - Houston, TX

December 2007 to January 2008

Responsibilities

Notified customers when service was completed and accepted payment and deposits. Analyzed bill Customer had a question or was dissatisfied. Made adjustments to accounts, such as refunds, credits, And e.t.c. set customers up with new service in their home, such as High Speed Internet service, Direct TV, Home Phone service, as well as Wireless service as well. Recommended certain planes and Packages for customers who is trying to save money in their home, up-selled products to new and existing Customers if they qualified, and provided excellent customer service to make sure that they were VERY SATISFIED!

Education

Business

Texas Southern University - Houston, TX

2006 to 2007

High school diploma or GED

Skills

• HIPPA QUALIFIED .. familiar with EOB, CPT CODES, and much more (6 years)

• Typing

• Data collection

• ICD-10

• Quality Audits

• Medical Billing

• ICD-9

• Customer service

Assessments

Customer service manager — Proficient

January 2022

Managing customer service representatives and resolving customer issues Full results: Proficient

Medical billing — Proficient

January 2022

Understanding the procedures and forms used for medical billing Full results: Proficient

Customer service — Proficient

January 2022

Identifying and resolving common customer issues

Full results: Proficient

Customer focus & orientation — Highly Proficient

January 2022

Responding to customer situations with sensitivity Full results: Highly Proficient

Call center customer service — Proficient

January 2022

Demonstrating customer service skills in a call center setting Full results: Proficient

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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