Customer Service Center Representative
Resume:
Candsadie Peake
Winter Springs, FL 32708
*********.******@*****.***
Summary
I have Experience of 15-20 years of billing and enrollment STD, I've dealt with Insurance all over life, worker's compensation I was able to make a difference in people's lives and help strengthen your community every day. When your neighbors need me to be there. Assisting with invoice billing for retiree plans while taking inbound calls in a call center atmosphere.
Skills
• Over three years of account and client management experience/more than 7 years of successful experience in customer service and support.
• Proven ability to lead successful programs and teams.
• Able to develop and implement policies and procedures
• Skilled in problem resolution and customer relations.
• Excellent presentation and communication skills.
• Ability to train, motivate and supervise other employees.
• A team player, acknowledged as "Total Quality Customer Service Professional."
• Trained and managed personnel
• Initiated prior authorizations
• Contact pharmacies regarding dispense status
• Assisted patients with co pay assistance with their prescriptions
• Proficiency in Word, Excel, Power Point, Microsoft Office, Outlook. Education
Hamilton High Hamilton, OH US 1995 – 1998
High School Diploma
Experience
Sears holdings/Transform Co. Jan 2019 to May
2022
Case Manager/Service Center Representative
• Assisting members with protection Warranty agreements for appliances
• Assisting with service orders being created for technicians and members
• Providing members with the best customer service satisfaction pertaining to any questions and concerns members may have towards the process for repairs and replacements agreement Reed Group May 2016 to June 2017
Service Center Representative/ Case Manager
• Act as an HR Business Partner by Managing Care Fusion’s employees STD /FMLA and medical administrative leave claims
• Conducting thorough investigations, making determinations regarding short-term disability eligibility for Care Fusion’s employees, provide ongoing claim administration, and communicate decisions and status updates to CareFusion HR representatives and Supervisors as well as employees via phone, email and mail correspondence.
• Prioritized my assigned caseload of short-term disability claims, and in accordance with established
• procedures/protocols, apply appropriate contractual provisions, legal guidelines, and case management resources to make claim determinations
• Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits.
• Evaluate and refer appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, Social Security, and Subrogation.
• Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits.
• Calculate liability for claims, applying appropriate offsets such as state benefits, workers compensation, and third parties.
• Demonstrate the ability to make and effectively communicate decisions within tight timeframes while integrating knowledge of medical conditions, customer contracts and their service level agreements.
• Continually and accurately document system and claim files on actions taken. Randstad/ Aon Hewitt June 2015 to May 2016
Service Center Representative/ Case Manager
• Act as an HR Business Partner by Managing Care Fusion’s employees STD /FMLA and medical administrative leave claims
• Conducting thorough investigations, making determinations regarding short-term disability eligibility for Care Fusion’s employees, provide ongoing claim administration, and communicate decisions and status updates to CareFusion HR representatives and Supervisors as well as employees via phone, email and mail correspondence.
• Prioritized my assigned caseload of short-term disability claims, and in accordance with established
• procedures/protocols, apply appropriate contractual provisions, legal guidelines, and case management resources to make claim determinations.
• Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits.
• Evaluate and refer appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, Social Security, and Subrogation.
• Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits.
• Calculate liability for claims, applying appropriate offsets such as state benefits, workers compensation, and third parties.
• Demonstrate the ability to make and effectively communicate decisions within tight timeframes while integrating knowledge of medical conditions, customer contracts and their service level agreements.
• Continually and accurately document system and claim files on actions taken. Sedgwick CMS Sep 2013 to May 2015
Service Center Representative/Claims Service Center Representative.
• FNOL intake for DS, FMLA, WC, for Lockheed Martin, UHG, NBC Universal, General Mills, Allina Health systems, Eaton Aerospace / Cooper, Comcast, Chrysler, including any and all subsidiaries for the listed organization/corporations
• Manage all action requests through all incoming and existing claims and assist Employees, Supervisors,
• Human resources and Medical doctors, Surgeons and all other medical personnel providing correct, accurate, and updated information and perform appropriate research for resolution.
• Coordinate with claims adjuster and financial department to resolve all claim issues and facilitate contracts according to established procedures and policies, maintain an effective claim system and adhere to all coverage and claim processing requirements.
• Administer all action request forms and ensure completion of all forms within required timeframe and train all providers and members to maintain knowledge on all policies and procedures.
• Gather all information from Employees, Supervisor, Human Resource, Doctors and medical personnel and various internal and external resources also perform the necessary action in order resolve, educate, and ensure return to work, open, close or cancel a claim appropriately.
• Review all claims and facilitate to make appropriate payments and document all claims services and provide support to all files.
• Ensure timely claim disposition of all Employee claims and manage all communication with clients and claimants.
• Support other branches with overflow, other responsibilities as requested, and function as extended
• Human resources department personnel under employee benefits. Catamaran Sep 2012 to Sep 2013
Customer Service Representative/ Benefits Specialist
• Quoting prescription copay Coordinating benefits
• Billing and Coding
• Verifying Prescription Coverage
• Updating Members Eligibility
• Assisting pharmacy with denial, reversals and Processing
• Initiated prior authorizations
ACS Pharmacy/ Omnicare Oct 2007 to May 2012
Customer Service Representative /Patient accounting/ Trainer
• Assisted with a team of 15-20 employees
• Trained new employees
• Verified insurance information
• Initiated prior authorizations
• Contact pharmacies regarding dispense status
• Assisted patients with co pay assistance with their prescriptions
Contact this candidate