Administrative & Customer Service Specialist with Medical Focus
Resume:
Donna Bennett Sandy Springs, GA
Highlights of qualifications
●Accomplished administrative and customer service professional with extensive experience overseeing operational management in the medical field. Call Center inbound calls, familiar with CMO plans
●Provide adequate administrative and analytical support, organizational systems, and client insurance claim data collection.
●A detail-oriented and highly motivated team player who readily participates in cross-functional teams to improve processes and procedures.
●Recognized for thorough, accurate, and timely production of reports and well-developed interpersonal, verbal & written communication skills. 2 + years as Payment Processor, inputting payments and balancing accounts.
●Proficient computer skills in Microsoft Office (MS Word, MS Excel, MS PowerPoint), Medical Terminology, ICD-9 Coding, PBX Operator, Opex Mail Opener, Password resets for providers/members, familiar with EPIC and IRCS systems, PeopleSoft, CRM, SAP, Salesforce and Optum. Typing 54 wpm-0 errors.
Education
●Medical Insurance Billing & Office Administration, Ross Medical Education Center, Ann Arbor, MI, 10/2009
●Associate of Arts, Medical Office Management, Davenport University, Dearborn, MI - 06/2003
Professional Experience
Sonder Health Plans - Atlanta, GA
Member Care Professional, Temp., - November 2024 - Permanent March 2025 - September 2025
●Answered 30 - 40 incoming calls from members, providers and agents benefit inquiries
●Provided benefits, copays, and maximum out of pocket amounts to members/prov
●Submitting complaints for member unpaid claims/issues regarding their supplemental benefits
Nesco Resources - Sedgwick Government LLC
Customer Service Rep., Temp., - June 2024 - October 2024
●Answered i30 - 40 incoming calls for 911 responders and survivors
●Checked claim status and authorizations for treatment services
●Provided eligibility and benefits information to providers/members
Robert Half / CARMAX - Kennesaw, GA
Admin. Asst. Customer Service Rep., Temp., Dec. 2021 – April 2023
●Answered 30 - 35 incoming calls for Auto Payoffs.
●Worked ESP/GAP que
●Processed Reinstatements and Stragglers
Kaiser Permanente - Duluth GA
Customer Service Rep. I Sept. 2019 - Sept. - 2021
●Answered 50 -70 incoming calls through CRM from members and providers regarding benefits
●Assisted prospect members with filling out online applications
●Set up members for auto pay and processed
Anthem – Mindlance, Atlanta, GA
Utilization Management Rep. I Feb. 2019 – June 2019
●Answered incoming 20 - 30 calls for Precertification and Prior Authorizations from hospitals, etc.
●Set up Precertification and Predetermination cases from hospitals and medical facilities
●Researched CPT procedural codes
Kaiser Permanente – On Call Buckhead, GA
Patient Services Representative – August 2018 – Jan. 2019
●Checked in members/non-members on medical health vehicle for flu shots and biometrics
●Assisted with medical health events
●Assisted with putting the equipment together and dismantling
Westat – Westport One Atlanta, GA
Customer Service Representative – Call Center April 2018 – August 2018
●I called participants to see if they would take the Maryland state transportation survey
●Processed demographic surveys
●Researched surveys not fully completed
Adecco - UnitedHealth Group, Atlanta, GA
Customer Service Representative – Call Center, Dec. 2017 – Feb. 2018
●Answered 30 - 60 incoming calls for Pain Recovery and Mental Health providers/members
●Answered inquiries regarding medical benefits
●Responded to member complaints
Delta Dental, Alpharetta, GA
Customer Service Representative - Call Center, June 2017 – Oct. 2017
●I answered 30 - 40 dental benefit calls for members and providers and checked eligibility, copays, etc.
●I enrolled new members for dental coverage
●Assisted members with finding dentists for dental care
CIOX Health, Alpharetta, GA
Client Service Representative - Med. Records Depart., Feb. 2017 – June 2017
●I answered 20 - 40 inbound calls for medical record requests from attorneys, hospitals, providers, etc.
●Processed medical record requests
●I did 5 - 10 miscellaneous medical record requests daily for follow-up
KAISER PERMANENTE, Buckhead, GA
Claims Processor / Member Services Rep. I - Sept. 2014 – Feb. 2016
●Answered 50 - 70 eligibility calls documented using CRM per day regarding benefits
●Verify the status of referrals and prior authorizations.
●Status medical claims, file complaints, and update member’s demographic information
HP Enterprise Services Georgia Medicaid, Tucker, GA
Claims Processor / Customer Support Representative – Call Center Inbound Calls, Oct. 2010 – Sept. 2014
●Answered 50 - 70 Medicaid claim status calls from providers and facilities using CRM
●Processed enrollment reports for Wellcare, PeachState, and DFCS.
●Report to upper management on enrollment stats once a week.
ACS XEROX, Atlanta, GA
Medicare / Medicaid Customer Care Representative – Call Center Inbound Calls, Oct. 2010 – Oct. 2010
●Received Medicaid claim assignments, reviewing claim and policy information to provide background for investigation.
●The claims were verified and analyzed data used in settling claims to ensure that claims were valid and that settlements were made according to company practices and procedures.
●Reviewed progress and status of claims, discussing problems and suggesting remedial actions.
RYLA TELESERVICES, Atlanta, GA
Census Interviewer – Inbound Calls Seasonal Assignment, April 2010 –July 2010
●I cold called 30 - 50 homes daily and conducted population surveys to collect government demographic information
●Researched and retrieved voicemail messages
●Followed - up voicemail messages
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