Customer Service Representative

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

Stonecrest,GA *****

423-***-****

MICHAEL S SHAW

OBJECTIVES: ·Customer Service ·Claims Research ·Medical Audits

EDUCATION: Woodmont High School Piedmont, South Carolina

1985 – 1989 Diploma

Advance Career training of Atlanta, Atlanta, Georgia

1989-1990

WORK EXPERIENCE:

CIGNA HEALTHCARE, Chattanooga, Tennessee

November 2001 – 2025

CUSTOMER SERVICE REPRESENTATIVE (LIFESOURCE UNIT)

· Assist regional and local customer on medical and dental inquiries

· Counsel local and out of town customers/providers on claims status,

medical/dental benefits, coordination of benefits, and eligibility

· Ensure proper contracting guidelines and procedures based on

members' individual medical plan

· Processed medical claims under standard claims processing protocol

· Train new and existing employees as technical coach for customer

service

· Serve as employee assistance counselor involved in company wide

events planning to support improvements in customer service and claims processing

· Recipient of the CIGNA Champion Award (seven) for excellence in

customer service/claims processing and support of company wide

projects

Transplant claims processor, adjustments and appeals processor.

CONVERGYS CORPORATION, Chattanooga, Tennessee

March 2001 – November 2001

CUSTOMER SERVICE REPRESENTATIVE (AT&T)

· Assisted AT&T residential customers with local and regional long

distance charges, state to state long distance charges, and international

phone charges

· Assisted agents in role of floor support

· Handled and resolved escalated customer calls

STATE OF GEORGIA/KELLY SERVICES, Atlanta, Georgia

1999-2001

UNDERWRITER SECRETARY

· Answered multi-line phone

· Retrieved and filed state case reports

· Assisted customers on status of disability eligibility

KELLY SERVICE (Blue Cross and Blue Shield), Birmingham, Alabama

1996-1999

CLAIMS PROCESSOR

· Processed medical claims based on established insurance claims

criteria

· Reviewed and edited claims for processing accuracy and adjusted

where appropriate

· Assist regional and local customer on medical and dental inquiries

· Counsel local and out of town customers/providers on claims status,

medical/dental benefits, coordination of benefits, and eligibility

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