Customer Service Claims Processing
Resume:
MARY JOHNSON
CONTACT
AMITE, LA 70422
********@*****.***
PROFILE
Results-driven professional with a strong track record in program administration, billing, customer service, and claims processing. Skilled in data analysis, problem-solving, and communication, with a proven ability to maintain accurate records and resolve customer issues efficiently.
EDUCATION
KAPLAN • MAY 2010
BACHELORS, ACCOUNTING
KEY SKILLS
Data analytics
Billing and Claims Management
Claims Processing
Computer Proficiency
Customer Service
Conflict Resolution
Budget Management
Leadership and Interpersonal Skills
Time Management
Pharmacy Benefit Management (PBM) Systems
Prior Authorization Support
HIPAA/PHI Guidelines
Pharmaceutical Industry Knowledge
EXPERIENCE
EVERISE • AUGUST 2023 -PRESENT
Responsible for answering 50 to 100 inbound calls daily from members to -Refill prescriptions -Send out requests to Dr. Helped guide members through their benefits information (Deductible, Out of pocket, etc.) and answered questions appropriately. Escalated callers with drug-related questions to the Pharmacist. Provided quotes to members with an estimated cost of medications when using Prime Mail, mail order pharmacy vs. local pharmacy. Awarded multiple certificates for very satisfied surveys from members. Met all performance goals such as first call resolution, quality calls, and customer satisfaction, all while providing world-class customer service. Answered inbound calls from pharmacies and doctor offices.
ALORICA • NOVEMBER 2019 – FEBRUARY 2023
Solution-oriented call center representative with five years of experience handling high-volume inbound calls. Diligent in-service skills, including understanding client concerns, offering prompt solutions, and enhancing client retention. Recognized for maintaining a calm demeanor under pressure and delivering high-quality support to maximize customer satisfaction.
RMS CARE PROVIDERS • FEBRUARY 2009 – OCTOBER 2019
Highly organized and detail-oriented professional with extensive experience in medical billing and administrative/clerical work. Proven track record of accuracy and efficiency in managing and processing healthcare claims. Resolve discrepancies between medical records and insurance claims. Ensure compliance with government regulations. Responding to insurance inquiries
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