Customer Service Legal Assistant

Faith Luben

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

Columbus, Georgia *1903

Cell: 706-***-****

Email: **********@*****.***

CAREER SUMMARY:

-Over 10 years of excellent customer service skills and a keen ability for detail.

-Fast learner and able to perform duties without immediate supervision.

-Performs multitasking with ease.

-A team player with intentions on helping a company attain goals. EXPERIENCE:

Delta Dental, Remote

Jan 2021- Jan 2022

Claims Processor

● Reviews Daily Inventory to determine workflow to maintain department turnaround time expectations.

● Receives and works queue inventory through the processing system.

● Research claims / pre-treatment estimates for supporting documentation including eligibility, applicable benefits, processing policies and coordination of benefits.

● Initiates manual requests for required supporting documentation.

● Researches, resolves and processes appeals, checks and paper workflow in folders to maintain the inventory levels according to department goals.

● Identify procedures requiring review and refer to appropriate consultant with all required documentation. Maintain tracking, decision and claim resolution of the referral within the system.

● Working knowledge of benefit coverage, processing policies, products and provider networks provided by DDCO.

● Responsible for maintaining and ensuring all procedures in the operations department follow HIPAA standards and regulations.

Maximus, Remote

May 2019- Nov 2020

Validator (Legal Assistant ll)

● Analyzing claim information to determine the cause of outstanding issues

● Assessing eligibility requirements based on UI Code, Policies and Procedures

● Evaluating wage and earnings

● Communicating with claimants and employers by phone to obtain missing information

● Notating all contacts and actions taken on a claim clearly and thoroughly

● Demonstrating the ability to make timeline and logical decisions Anthem, Columbus, Georgia

Jan 2017- April 2019

CSR

● Codes and processes claim forms for payment ensuring all information is supplied before eligible payments are made.

● Reviews, analyzes and processes claims/policies related to events to determine extent of company’s liability and entitlement. Researches and analyzes claims issues. Responds to inquiries, may involve customer/client contact.

● Use a PC, database system, and related software (word processing, spreadsheets, etc.). TSYS, Columbus, GA

Oct 2015- Jan 2017

Customer Service Representative

● Receives and/or places telephone calls which are predominantly routine, but may require deviation from standard screens, scripts, and procedures.

● Answer customer telephone inquiries, orders, service needs and complaints, respond where applicable or direct to technical/service areas. Maintain detailed and current knowledge of the company's/assigned client's products and services.

● Analyze customer service needs for communication to service and technical departments, when applicable. Requires ability to navigate a computerized data entry system or other relevant applications.

EDUCATION :

HS Diploma

REFERENCE:

Available upon request

Contact this candidate