Data Entry Customer Service
Resume:
Tiffany A. DeFelice
** ***** ******* **** • Mechanicville, NY 12118 • 518-***-****)
****************@*****.***
Summary
I am currently seeking a position that will offer me new and exciting challenges, along with an opportunity to grow within the company. I have experienced different levels of responsibility, taken steps to grow my skillset and am ready to take the next step in my career. Highlighted skills:
Communication
Computer- Office/Outlook
Critical Thinking
Customer Service
Process Improvement-Efficiencies
Relationship Management
Team Building
Training
Professional Accomplishments
Recipient of the Commitment and Accountability Award in 2014, and 2015
Received the Heart of CDPHP Award in 2020 & 2022
Participated in and coordinated charity effort for IO Helping Hands Committee multiple years
Work History
Team Lead, CDPHP 9/2022-present
Demonstrated ability to apply problem-solving methodologies to organizational and departmental problems while maintaining compliance with established policies, procedures, and regulations.
Experience with Macess, Facets and Formworks.
Working knowledge of online desk levels.
Strong time management skills, including self-directed scheduling.
Staff training.
Working knowledge of regulatory requirements that affect the health insurance industry.
Correspondence review and data entry.
Document Services Representative, CDPHP 4/2019 to 9/2022
Responsible for developing, performing, and tracking the training of new hires and reporting back to management.
Lead on establishing more efficient processes for timely distribution of critical documents, while building connections and developing internal customer relationships.
Accurately review, sort, and prepare the daily receipt of all correspondence documents according to established Desk Levels.
Review all scanned correspondence images in Formworks and utilize and interpret Desk Levels to ensure the accurate creation and routing of workflow items in the Macess EXP Doc Flo system.
Consistently exceeds Production and Quality metrics established within the department.
Report any system, scanning, data entry, or workflow issues to management as appropriate.
Claims Representative, CDPHP 04/2017 to 04/2019
Research and analyze claim edits to make appropriate benefit determinations utilizing established policies and procedures, medical coding guidelines, medical records, applicable pricing databases, plan contract language, riders and schedules.
Maintain Claims production and Quality metrics as established by the department (Received IO Executive Club Award for Quality in 2018).
Research and contact appropriate people as warranted for information needed in all types of Claims related inquiries using the Claims Adjudication system and databases, contracts and plan policies and procedures.
Initiate and assist in the development of process improvements necessary to resolve Claim Adjudication barriers and system limitations.
Apply various COB methodologies, based on specific guidelines, in conjunction with interpretation of submitted EOBs.
Document Services Representative, CDPHP 01/2012 to 04/2017
Promoted and cross trained on multiple jobs within the department
Accurately review, sort, and prepare the daily receipt of all correspondence documents according to established Desk Levels.
Review all scanned correspondence images in Formworks and utilize and interpret Desk Levels to ensure the accurate creation and routing of workflow items in the Macess EXP Doc Flo system.
Consistently exceeds Production and Quality metrics established within the department.
Report any system, scanning, data entry, or workflow issues to the Team Lead, Document Management, and/or a member of management as appropriate.
Small Group Sales (Marketing Temp), CDPHP 11/2011 to 01/2012
Responsible for putting together brochures, packets, and other duties as needed for Open Enrollment.
Education
Some College: Early Childhood Development
HVCC
High School Diploma:
Stillwater Central School
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