Customer Service Representative

Carolyn Leahy

***** * ********* ****, # ***, Irving, TX 75063

M: 469-***-**** / E: *******.*****@******.***

Summary of Qualifications:

•10+ years of experience processing client claims, rendering final decisions

•20+ years of detailed oriented work and meeting client expectations

•Able to perform independently and prioritize assigned tasks to meet or exceed department expectations

Employment History

WEB-TPA Irving, Texas

Customer Service Representative July 2010 – Present

Customer Service APA Pod CS Rep. February 2010 – June 2010

Senior Claims Examiner January 2000 – February 2010

WEBA-TPA Nineteen Years’ Experience Summary

•Adhere to Customer Service matrix

•Maintain high rate of accuracy in calls and system notes

•Call backs to customers, as needed

•Accurate information to providers and members concerning benefits and eligibility

•Department goals are consistently met

•Maintain professionalism during phone calls with providers and members

•Built strong relationships with assigned client accounts

•Effectively manage 11,000 member portfolio with quality assurance guarantees

•Consistently rendered final decision for payment or denial

•Met daily quotas or exceeded Department standard for number of claims processed

•Met or exceeded quarterly client performance guarantees

•Interpretation of insurance policy terms

•Coordinate with business partners and co-workers for the processing of client claims, resolution of issues, facilitate claim investigations and negotiate settlements

•Gathered and completed research on pre-existing conditions and coordinated benefits with outside insurance companies and Medicare and Medicaid

Industry Tools/ Software; Auto Audit, Encoder, and Code Manager

Insurance Standard; CPT and ICD-9 coding for medical, dental, vision, and mental health claims

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