Customer Service Representative

Yolanda A. Sanders

Phone: 757-***-****

Email: *****************@*****.***

Objective:

Seeking a position in the claim representative role with experience in providing efficient and effective claim services. Skilled in evaluating claim details, negotiating settlements, and maintaining a high level of customer service satisfaction. Demonstrates excellent communication skills, attention to detail, and adaptability in a fast paced environment.

Education:

Bachelor of Science, May 2001, Salem State College, Salem, MA.

Associate in Liberal Arts, North Shore Community College, Lynn, MA.

Computer/Office Skills:

Microsoft Office Suite: Word, Outlook, Excel, PowerPoint, and Internet Explorer. Data entry, multi-phone line system, and standard office equipment.

Related Work Experience:

Excellent written and verbal communication skills

Ability to learn rapidly to develop knowledge and understanding of claims practice

Ability to identify, analyze and solve problems

Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets

Strong interpersonal, time management and organizational skills * Ability to meet or exceed performance competencies

Ability to work both independently and within a team environment

Wisconsin Physicians Services Insurance Corporation

Remote

Claims Rep

4/20-2/25

Investigates and settles claims for military

Process insurance claims, determine coverage, authorize payments and negotiate settlement

Split claims to be separated to pay by year.

Adhere to production standards regarding availability, quality, and attendance.

Determines proper handling and adjudication of claims following organizational policies and procedures.

Use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, polices and procedures allowing timely considerations to be generated using multiple systems.

Applies training materials, correspondence and medical policies to ensure claims are processed accurately.

APAC

Newport News, VA

Claims Auditor/Toll Billing Agent

12/09-12/18

Audit and approve or deny reimbursement requests on aggregated excess claims.

Operate within established limits and guidelines to ensure timely and accurate reimbursement.

Finalize claims for lost or damaged merchandise.

Respond to customer inquiries, and provide high levels of customer service.

Adhere to production standards regarding availability, quality, and attendance.

Record and verify names, addresses, purchases, and prospect status.

Input orders into computer

Contact this candidate