Service Representative Customer

CYNDIE HUDSON

**** * **** ****** ** Blaine WA· 206-***-****

************@*****.***

SKILLS

EXPERIENCE

NOVEMBER 2021 - PRESENT

SENIOR ACCOUNT SERVICE REPRESENTATIVE, PREMERA BLUE CROSS–SHARED ADMINISTRATION CLAIMS The Account Service Representative, Senior provides timely, accurate, courteous, and concise responses to escalated inquiries in person, by telephone, or by correspondence. Act as a liaison between the Marketing Department, group contacts, and special accounts to coordinate the resolution to inquiries with internal departments and provide contract and claim assistance. Serves as a in person liaison between internal and external producers, as well as existing customers, resolve complex issues and concerns for dedicated accounts, and provides educational information to clients, business and channel partners. AUGUST 2018 – NOVEMBER 2021

CLAIMS PROCESSOR 5, PREMERA BLUE CROSS–SHARED ADMINISTRATION CLAIMS Researches and resolves complex Shared Administration claim and system issues. Subject matter expert working with Facets, NASCO, HIPPA, Blue2, CSW, & Ultera. Completes processing of new claims, claim adjustments, large dollar, & and transplant packet processing. Works closely with Customer Service, Business Analysts, & Account service Representatives. Handles claims and customer service escalations for both support staff and team leads. Updates procedures and assists with training and auditing. JUNE 2006 – AUGUST 2018

CLAIMS PROCESSOR 2,3,4, PREMERA BLUE CROSS-BLUE CARD HOST/ SHARED ADMINISTRATION CLAIMS Handle all Customer Service Claims routes including adjustment and escalations, and all reprocessing projects. Completed all Blue Card Host large dollar audits. Assisted with procedures, training, auditing and processor questions. Review, research & resolve claims benefits issues. Identify, research, and resolve subrogation and general benefit inquiries. Enter and adjust complex claims. Meets with processors on question time. JANUARY 2005 – JUNE 2006

CLAIMS PROCESSOR 2 &3, PREMERA BLUE CROSS-BLUE CARD HOST CLAIMS Handle telephone inquiries regarding claim adjudication, provider contract pricing, & billing. Communicated with provider’s offices with consistency and professionalism. Respond to written provider inquiries. Follow up using both excellent written and phone communication on basic claims inquiries and complex claims processing. SEPTEMBER 2001 – NOVEMBER 2004

ACCOUNT INSURANCE SPECIALIST, DRUGSTORE.COM

First level of contact for customer care employees regarding general pharmacy questions and mail order partner escalations. Provided administrative support to Vice Presidents of Healthcare Services and Operations. Work closely REFERENCES AVAILABLE UPON REQUEST

with account managers to ensure the pharmacy team stays apprised of all current issues/questions that are flowing through all the mail order partners. Assist and resolve escalated customer issues, including order, fulfillment and shipping.

REFERENCES AVAILABLE UPON REQUEST

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