Customer Service Representative
Resume:
Tiffany Craig
Winnsboro, S.C. ***80
Education
****-**** *******, ********* ******* High School
****-**** ******** ********* ******* (2003)
Employment History
Dentaquest 2014 - 2022
Customer Service Representative 1
•Assisted with dental and vision benefits, claims, and any other concerns pertaining to the member's policy.
•Provided detail information that pertained to the member's claims processing and benefits available to the member and providers.
•Assisted member's with provider's that accepted their insurance for their vision and dental needs.
•Submitted medical records, X-ray details, diagnostic records to the medical & vision department for processing.
•Researched and processed claims that needed to paid that were denied in error..
•Responsible for taking 125 calls per day and working follow- ups that needed to be worked for processing to pay providers and members
•Handled incoming & out coming calls to member's and provider's
•Mailing out requested information
• Researching complex issues for customer call back.
• Sent requests to have checks voided and reissued
• Sent documents to be imaged and keyed to the system that were received
from members and providers.
•Updated addresses and phone numbers for member's and providers.
BlueCross BlueShield of South Carolina 2006 - Present
Individual Membership Customer Service Claims Advocate II 2012 - 2014
• Assisting with questions on Individual policies to include billing
issues, health care reform, and claim status.
• Used Live OPs and Membership and Billing desktop
• Mailing out requested information
• Researching complex issues for customer call back.
• Sent requests to have checks voided and reissued
• Sent documents to be imaged and keyed to the system that were received
from members and providers.
Subrogation MSR I 2010 – 2012
• Updated accident questionnaires determining if it should be loaded as a
negative or positive
• Determine if member needs to speak with an Adjuster.
• Informed members if the questionnaires were received and if the claims
were adjusted
• Keyed Rapid Files, Indexed questionnaires, faxed the adjusters work load
to attorneys and third party insurances
Customer Service Rep I 2006 - 2010
• Responsible for handling incoming and outbound calls.
• Explaining insurance claims, giving benefits information to providers.
• Sending inquires to other BCBS agencies in regards to whether the claims
processed correctly. Also checking on what additional information is
needed to process the claim. Send letters to the appropriate providers,
explaining whether the claim processed and/or what additional information
is needed to process the claim.
Wachovia 2002 - 2006
Customer Service Rep I.
• Responsible for handling incoming and outbound calls
• Explaining bank statements and offering different products that benefits
the customer
• Open new accounts, provide refunds on bank errors, and educate customers
on their existing accounts
• Handle disputes on customer’s bank statements by contacting the merchants
responsible for the charges
BellSouth 2000 - 2002
Customer Service Rep I.
• Responsible for handling incoming calls.
• Explaining billing issues, while looking over customer’s bill and making
adjustments when need be
• Setting up new contracts, disconnects and also taking supervisor calls
Tiffany Craig
42 Orchard Dr.
Winnsboro, S.C. 29180
Education
1991-1995 Diploma, Fairfield Central High School
1995-1997 Midlands Technical College (2003)
Employment History
Dentaquest 2014 - 2022
Customer Service Representative 1
•Assisted with dental and vision benefits, claims, and any other concerns pertaining to the member's policy.
•Provided detail information that pertained to the member's claims processing and benefits available to the member and providers.
•Assisted member's with provider's that accepted their insurance for their vision and dental needs.
•Submitted medical records, X-ray details, diagnostic records to the medical & vision department for processing.
•Researched and processed claims that needed to paid that were denied in error..
•Responsible for taking 125 calls per day and working follow- ups that needed to be worked for processing to pay providers and members
•Handled incoming & out coming calls to member's and provider's
•Mailing out requested information
• Researching complex issues for customer call back.
• Sent requests to have checks voided and reissued
• Sent documents to be imaged and keyed to the system that were received
from members and providers.
•Updated addresses and phone numbers for member's and providers.
BlueCross BlueShield of South Carolina 2006 - Present
Individual Membership Customer Service Claims Advocate II 2012 - 2014
• Assisting with questions on Individual policies to include billing
issues, health care reform, and claim status.
• Used Live OPs and Membership and Billing desktop
• Mailing out requested information
• Researching complex issues for customer call back.
• Sent requests to have checks voided and reissued
• Sent documents to be imaged and keyed to the system that were received
from members and providers.
Subrogation MSR I 2010 – 2012
• Updated accident questionnaires determining if it should be loaded as a
negative or positive
• Determine if member needs to speak with an Adjuster.
• Informed members if the questionnaires were received and if the claims
were adjusted
• Keyed Rapid Files, Indexed questionnaires, faxed the adjusters work load
to attorneys and third party insurances
Customer Service Rep I 2006 - 2010
• Responsible for handling incoming and outbound calls.
• Explaining insurance claims, giving benefits information to providers.
• Sending inquires to other BCBS agencies in regards to whether the claims
processed correctly. Also checking on what additional information is
needed to process the claim. Send letters to the appropriate providers,
explaining whether the claim processed and/or what additional information
is needed to process the claim.
Wachovia 2002 - 2006
Customer Service Rep I.
• Responsible for handling incoming and outbound calls
• Explaining bank statements and offering different products that benefits
the customer
• Open new accounts, provide refunds on bank errors, and educate customers
on their existing accounts
• Handle disputes on customer’s bank statements by contacting the merchants
responsible for the charges
BellSouth 2000 - 2002
Customer Service Rep I.
• Responsible for handling incoming calls.
• Explaining billing issues, while looking over customer’s bill and making
adjustments when need be
• Setting up new contracts, disconnects and also taking supervisor calls
Contact this candidate