Customer Service Travel Agent

Tuvara Lee

*** ******* *****, ********, ********* 37064 615-***-**** ******.****@*******.***

Objective

To serve as an experienced customer service rep who is passionate about building customer service relationships while also defusing customer situations. A way to showcase my enhanced skills to communicate, organize, motivate and develop personal relationships with coworkers and customers while giving excellent customer service. Seeking to move up to become a great lead while also teaching less experience reps how to handle customer situations. Education

HIGH SCHOOL DIPLOMA MAY 1999 FRANKLIN HIGH SCHOOL, FRANKLIN, TENNESEEE Key Skills

Interpersonal Skills

Conflict Resolution

Decision Making

Project Management

Customer Service

Report & Document Preparation

Spreadsheet & Database Creation

Computer & Technical Literacy

Multi-tasking/Adaptability

Self-Motivation

Meeting & Event Planning

Inventory Management

Team Building & Management

Time Management

Creativity & Adaptability

Work Experience

MULTIPLAN NAPERVILLE, ILLINOIS AUGUST 2021 - PRESENT MEDICAL CLAIMS INVESTIGATOR AUGUST 2021 - PRESENT

• Audit large volume of claims to identify errors in payment

• Adhere to all state and federal guidelines and regulations

• Reviewing EOBS, HCFA’s, and UB92’s to understand the overpayment error

• Maintain proficiency in all technical applications (technical skills and system knowledge)

• Adhere to individual and monthly recovery goals

• Adhere to reimbursement policies and contract compliance

• Pay special attention to detail

• Accessing multiple Client systems and databases

• Process monthly reports to Clients for approval

• Set up meetings with Clients and serve as a liaison between the multiple clients and the team

• Relay meetings reports with management and teams to make sure we are meeting client demands

• Building relationships with client management such as CEO, CFO, Business Office Managers, Supervisor’s while discussing client and request and responses from team. OPTUM HEALTHCARE FRANKLIN, TENNESSEE MAY 1999- APRIL 2021 RECOVERY RESOLUTION SPECIALIST UHC DEPT JUNE 2019-APRIL 2021

• Audit large volume of claims to identify errors in payment

• Adhere to all state and federal guidelines and regulations 2

• Reviewing EOBS, HCFA’s, and UB92’s to understand the overpayment error

• Maintain proficiency in all technical applications (technical skills and system knowledge)

• Adhere to individual and monthly recovery goals

• Adhere to reimbursement policies and contract compliance SR. RECOVERY RESOLUTION SPECIALIST CENTER OF EXCELLENCE OCT 2014 - MAY 2019

• Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customers.

• Identifies and resolves operational problems using defined processes, expertise and judgment

• Act as the customer service advocate by answering questions via telephone or email and by providing support in researching and resolving issues

• Investigate claim and/or customer service issues as identified and communicate resolution to customers

• Provides expertise and customer service support to members, customers, and/or providers

• Has an extensive work experience within own function

• Works independently and often acts as a resource for others to help coordinate activities

• Use Multiple Client systems to review claims and verify if updates have been made correctly

• Quickly and accurately identify and assess customer issues and resolve the issues real-time

• Maintain proficiency in all technical applications (technical skills and system knowledge)

• Provides invoicing and reporting for assigned clients

• Has access to multiple client systems and is able to efficiently navigate

• Investigate claim and/or customer service issues as identified and communicate resolution to customers

• Review provider data and process provider appeals RECOVERY RESOLUTION SPECIALIST CASH TEAM JAN 2014 - OCT 2014

• Making outgoing calls and receiving incoming calls from Providers regarding insurance payments

• Using Client systems to review claims

• Requesting refunds from Providers on insurance claims that have been paid incorrectly

• Reviewing EOBS, HCFA’s, and UB92’s to help provider understand the overpayment error

• Explaining coding errors regarding CPT codes, Diagnosis codes, and ICD-9 codes

• Determining coordination of benefits on insurance claims

• Responsible for maintaining route compliance on approximately 4000 accounts

• Review provider contracts to determine possible refund discrepancy

• Skip tracing to locate providers of contact

• Ensure collections contract compliance including federal law, state law and HIPAA

• Responsible for meeting individual monthly goals that are set according to department goal

• Responsible for obtaining average calls on a weekly basis

• Act as the customer service advocate by answering questions via telephone or email and by providing support in researching and resolving issues

• Process appeals to the appeals department for further review

• Adhere to individual and monthly recovery goals

• Recommend and implement process improvement

• Act as the customer advocate by answering inquiries via telephone and email, providing support, researching and resolving issues, process appeals and claims processing knowledge

• Improve productivity by listening attentively to customer inquiries and meeting customer expectations through first contact resolution

SR. RECOVERY RESOLUTION SPECIALIST III PRS DEPT AUG 2000-DEC 2013

• Making outgoing calls and receiving incoming calls from Providers regarding insurance payments

• Using Client systems to review claims

• Requesting refunds from Providers on insurance claims that have been paid incorrectly

• Reviewing EOBS, HCFA’s, and UB92’s to help provider understand the overpayment error

• Explaining coding errors regarding CPT codes, Diagnosis codes, and ICD-9 codes

• Determining coordination of benefits on insurance claims

• Responsible for maintaining route compliance on approximately 1500-2500 accounts

• Review provider contracts to determine possible refund discrepancy

• Skip tracing to locate providers of contact

• Ensure collections contract compliance including federal law, state law and HIPAA

• Responsible for meeting individual monthly goals that are set according to department goal

• Responsible for obtaining average of a minimum of 50 calls and 25 contacts on a weekly basis

• Act as the customer service advocate by answering questions via telephone or email and by providing support in 3

researching and resolving issues

• Certified ORS Floor Trainer for New Recovery Analysts

• Project leader

• Recommend and implement process improvement

• Act as a customer advocate by answering inquiries via telephone and email, providing support, researching and resolving issues, process appeals and claims processing knowledge

• Improve productivity by listening attentively to customer inquiries and meeting customer expectations through first contact resolution

RECOVERY RESOLUTION SPECIALIST CASH TEAM MAY 1999-AUG 2000

• Access multiple platforms to review claim provider refunding

• Access data files to process payments

• Call providers and members to gather more information for payment processing

• Research and investigate all documentation sent by provider

• Prepare and take cash deposits to bank

• Post checks from providers and facilities to patient’s accounts References Available Upon Request

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