HR, Customer Service, Claim Eligibility, Appeals and Grievances
Resume:
Kerry Henson
AZ. *****
*****.******@*****.***
Profile
Experienced and detail-oriented Claims Examiner with a background in telecommunications, banking, and eligibility processing. Adept at reviewing complex claims, verifying eligibility, and ensuring regulatory compliance. Brings a unique perspective as a military spouse, demonstrating resilience, adaptability, and a strong commitment to service. Skilled in using claims management and data systems to streamline processes and enhance accuracy. Skilled in customer service, order processing, financial operations, and systems such as CRM and Linux-based platforms. Proven ability to thrive in dynamic, fast-paced environments while maintaining precision and professionalism. Adept at balancing personal resilience with professional excellence in both team-oriented and independent roles.
Key Skills:
• Telecommunications Operations
• Banking & Financial Services
• Linux/Unix System Familiarity
• Order Writing & Data Entry
• Customer Service Excellence
• CRM & Enterprise Systems (e.g., Salesforce, SAP)
• Conflict Resolution & Communication
• Flexibility in High-Mobility Lifestyles
Experience
Order Writer – Telecommunications (Pacific Bell/SBC/AT&T)
Handled complex telecom service orders, verified system configurations, and provided support for customer provisioning. Used Linux-based systems for backend processing.
United Healthcare
Banking Associate – Bank of America
Supported daily operations including account management, teller transactions, and financial reporting. Focused on accuracy, confidentiality, and customer satisfaction.
United Healthcare
Claims Eligibility Rep
2/22 to 08/24
Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing ability.
Applies medical necessity-guidelines, decides coverage, completes eligibility-verification discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.
Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.
Ensuress all compliance requirements are satisfied and all payments are made against company practices and procedures.
Identifies and reports claim overpayments, underpayments, and any other irregularities.
Performs claim rework calculations.
Distributes work assignment daily to junior staff.
Trains and mentors claim benefit specialists. -- Makes outbound calls to obtain required information for claim or reconsideration.
State of Arizona
Adjudicator
11/2020 thru 02/2022
Adjudicate claims for benefits offered by the government.
Work on cases assigned by the government to determine: (1) a person's eligibility for various Social Security or workers' compensation benefits, (2) protection of the environment, (3) the enforcement of health and safety regulations, (4) employment discrimination, and (5) compliance with economic regulatory requirements.
Review the applicant's case and examine the background.
Check all reports and facts thoroughly, including criminal history, immigration and citizen status, and intelligence reports.
Prepare analysis for the government recommending specific courses of action.
Show justification for recommended course of action.
Maintain security clearance.
Research and analyze laws, regulations, policies, and precedent decisions to prepare for hearings and to determine conclusions * Issue subpoenas.
Determine existence and amount of liability according to current laws.
Authorize payment of valid claims.
Compromise on settlements.
Monitor activities of trials and hearings.
Explain rulings to claimants and how they may appeal.
Prepare written decisions.
Evaluate claim applications, birth and death certificates, and employer records.
NCO/T-Mobile
Workforce Supervisor
11/2005 to 09/2008
As Work Force Supervisor I am proficient in real time call center operations, staffing curves, call center metrics, scheduling. I am responsible for ensuring that call center resources are utilized to provide optimum service levels for customers. I am also responsible for creating; formatting, maintaining, and producing reports for tracking movement of agents on a weekly basis from one skill group to another as well as speaking to client required, pre-scheduled and post scheduled as well actual staffed agents for each day of the week for all skills. I am also responsible for all scheduling with Aspect EWF and have experience in Blue Pumpkin and Right Force. I am also responsible for real time management of all skills in CMS as well as assignment of skills and groups and offering real time management of agents staffed. I have added bullets which will give a more in depth list of my responsibilities. Review all email for exceptions and add them when needed. Check schedules for accuracy and review Supervisor exceptions for failures also schedule all clients training for the production floor. Unlock accounts and file help desk tickets for both NCO and T-Mobile. Answer all questions from Supervisors about agent’s schedules and PTO requests. Run all Avaya CMS reports for Supervisors and Director for either agents or teams responsible for adding, deleting agents and assigning skill sets and building new teams and making additional changes to existing teams also adding new Supervisor user IDs in Avaya and assigning what reports and skills they may or may not have access to. Working knowledge of all systems databases including Vasa, Remedy, Streamline, Sampson and Onyx. I have excellent knowledge of all application error messages, which enables me to report to T-Mobile immediately any ongoing issues so that trouble tickets can be opened to get the issue resolved in a timely manner so that our Service Levels are not affected. Assist new Supervisors with understanding aspect and the reporting capabilities the software has as well as understanding Site KPI requirements. Maintain all audit information for Workforce Management for the site. I am also responsible for submitting all NCO Domain ID’s and all of T-Mobile ID’s as well as terminating them when the agent is separated voluntary or involuntary. I currently am in charge of approximately 300 agents. I was also responsible for maintaining accurate staffing curves for the different skills In each LOB that we currently had at NCO/T-Mobile. Constant analysis of agent’s schedules versus the locked forecasts from clients to insure we are staffed 24/7 in all skills types. Real time calls queue management. Provide Clear Concise Statistical Reporting. I also manage multiple queues to ensure maximum Occupancy and Agent availability. One of my other major key functions in my position is working with Site Director and our Production Managers and Supervisor to achieve site growth and profitability.
ESSENTIAL DUTIES AND RESPONSIBILITIES: Client contact for Yuma Workforce Client calls to for IDP’s, Weekend Reports and Locked Forecasts Creating Scheduling Forecasts in EWF for 300 Agents Creating Shrinkage Workbooks in EWF (Weekly) Adding and deleting Employees in EWF Employee Maintenance in EWF Adding/Changing TCC times/Training schedules for NH.
Auditing Locked Forecasts. Entering Overrides from Locked. Creating Shifts to Hire to (for
Recruiting /New LOB) Running Schedules Optimizing Breaks Approving all shift changes
Permanent/Temporary Tracking shift types PTO/Vacation Approval PTO/Vacation Tracking
Scheduling Training (Client training) Weekend Report (Friday) Reviews on Monday with Client
Client IDPs (Monday and Friday Edition) FTE Tracker Hierarchy vs. FTE Tracker Report APS
Reports to T-Mobile Executive’s.
Pacific Bell/SBC
Customer Service Representative
10/99 to 04/03
Coordinate and execute sales of voice and data products and services in EPC (Emerging Products Center) for leading Telecommunications Company. Specialty Call Center dealing with customer inquiries about DSL ordering and billing issue’s and adjustments as well as regular Landline issues, issuing credit to customers and running credit checks updating all information in systems. Writing N, T&F and C orders also correcting orders containing errors, address verification per premise systems and writing new service orders pertaining to new customers ordering service. Write intricate DSL orders for Residential customers confirming system limitations and compatibility. Modify incorrectly written orders requiring Fielded visits (Technicians visits). Trouble shooting why either Landline or DSL is not working, and issuing new orders to correct database system and errors. Manage territory-wide inbound/outbound sales and new account development. Conduct comprehensive needs analysis to provide custom solutions for a wide range of residential customers. Facilitate efficient resolution of customer issues; regularly interact with customers to provide current product information and drive promotional initiatives. Prepare and process timely sales documentation. Effectively employ sales automation tools. Forge and cultivate positive internal and external residential relationships. Serve as corporate representative advancing business development via community relations programs (ex) Fairs, Swap Meets and Community Events. Effectively employ retention program to save customer accounts.
EDUCATION Graduated Yuma School District One 06/1993
Contact this candidate