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Service Representative Claims Examiner

Location:
Denison, TX
Salary:
12.00 hr
Posted:
June 16, 2023

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Resume:

Jennifer Mize

Dedicated Consultant and advisor for county homeless shelter/advocacy for victims of

domestic abuse

Denison, TX 75020

adxqla@r.postjobfree.com

+1-214-***-****

Authorized to work in the US for any employer

Work Experience

Residential Advisor (RA)

Grayson county homeless shelter - Denison, TX

February 2018 to Present

Part time

Dedicated Consultant

UNITED HEALTHCARE

2007 to 2009

Promoted (based on Client request) to serve onsite as dedicated consultant for 7500 member account. Managed all aspects of account; including provider relations, claims, care / benefits coordination, and open

enrollment. Performed issue and outcome tracking and provided detailed notes / reports.

• Received "Excellent Servicing" ranking with 100% annual survey feedback.

• Recognized for "Outstanding Customer Service" by the Travis County Commissioners Court and County Judges.

• Saved approximately 40 hours every six months, while saving client and claimant money, by identifying and addressing reoccurring claims issue. Worked with cross-functional Installation Department to resolve issue.

• Significantly reduced calls from claimants and providers by identifying and resolving issues involving policy numbers. Initiated alert system and trained 40 dedicated Customer Service Representatives on new process; resulting in reduction in re-submittals of claims to 0. Advocate

United health care - Plano, TX

2002 to 2009

Client Advocate

UNITED HEALTHCARE

2004 to 2006

Served as liaison to complex customer base consisting of 7,650 members. Addressed, responded to, and resolved escalated issues with external and internal clients. Managed overall delivery of benefits and services by providing direct support and guidance to existing and potential clients. Conducted product presentations.

Claims Processor

UNITED HEALTHCARE

2002 to 2004

Processed 175 claims per day for two of company's highest profile accounts.

• Received "Spot Award" in 2004 for demonstrating dedication and hardworking qualities.

• Consistently met goal for 100% quality work produced. 2800 Bartons Bluff Lane #2502 * Austin, TX 78746 * 512-***-**** * adxqla@r.postjobfree.com Customer Service Representative

EWING AUTOMATS / MERCEDES BENZ - Plano, TX

2000 to 2002

Provided top quality service to high profile clients. Medical Assistant

ENDIVE HEALTH SERVICES - McKinney, TX

1999 to 2000

Served as assistant for this occupational health facility. Performed customer servicing and drug testing. Contacted employers with drug testing results. Provided feedback on Workman's Comp claims. Claims Examiner

TOTAL PLAN SERVICES / TRUSTMARK - Dallas, TX

1999 to 1999

Processed medical and dental claims for third party administrator. Claims Adjuster

CONSUMER PLUMBING - Plano, TX

1995 to 1997

Claims examiner for this Consumer Plumbing Company. Obtained adjusters, Class B license. Examined claims for class action law suit for homeowners with defective plumbing. Eligibility Analyst

BLUE CROSS / BLUE SHIELD - Dallas, TX

1993 to 1995

Entered eligibility coverage for insured members and performed data entry. Dealt directly with customer and human resource departments regarding medical insurance eligibility for members. Education

Associates in Business Management

Collin County Community College - Plano, TX

Certifications and Licenses

General lines insurance licence

March 1995 to February 2022

Additional Information

TECHNICAL SKILLS

Typing 60+ wpm * 10-Key * Excel * MS Word * MS Access * MS Outlook * eTRAC Systems



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