Insurance Customer Service & Claims Processing

TRACEY AUTRY ROBINSON

**** ******* ****** 336-***-****

High Point, NC 27263 ***************@*****.***

SUMMARY

A hardworking and highly dependable administrative professional with a solid background in office management, scheduling, data entry and customer service. Possess capabilities in accounts payable, medical claims management, client relations, and customer complaint management and resolution. A performance-driven and dedicats and implements programs to achieve corporate initiatives.

EXPERIENCE

CONDUENT Fordham Park, NJ

Insurance Customer Service, 1/2022- 12/2023

ed producer who utilizes resources to assure customer satisfaction and continued business. Develop

●Work From Home

●Benefit Explanation

●Claims Appeals Processing

●Provider Recertification (Credentialing)

●Provider Benefit inquiry

●Claim payments Application

BROADPATH High Point, North Carolina

Provider Services Representative, 10/2021- 01/2022

●Work From Home

●Authorization and Pre-certification processing

●Benefit explanation for providers

●Claims re-coding/ re-processing for providers

●Provider Benefit inquiry

●Claim payments

●Claim payment recoupment

●Provider coordination of care assistance

CVS / AETNA High Point, North Carolina

Aetna Customer Advocate, 12/2020 - 09/2021

●Work From Home

●Claims Processing/ Reconsideration as needed

●Benefit and Policy Exclusion Explanation

●Appeals Processing

●Authorization and Precertification Expedition

●Benefit Interpretation (Exception processing)

●Eligibility and Enrollment Coordination with HR and Marketplace Vendors

●Benefit Explanation

●Appointment-Setting

●Provider Benefit Inquiries

NATIONAL GENERAL INSURANCE, Winston Salem, North Carolina

Insurance Services Advisor, 1/2019 - 12/2019

●Coverage Clarification

●Technical System Support for Agencies

●Endorsement Processing

●Policy Changes and Updates

●Escalations Routing

●Peer Support/ Floor Walking

UNITED HEALTHCARE, Greensboro, North Carolina

Health Advisor, 2012 - 2017

●Work From Home

●Benefit Explanation

●Eligibility Problem Resolution

●Health Insurance Escalation Routing

●Claims processing and correction as needed

●Plan explanation and network status problem resolution

●Plan exclusion explanation

NCO CALL CENTER, Greensboro, North Carolina

Package Tracking Specialist, 2009-2012

●Provided product descriptions and requirements for package shipping

●Informed clients of tracking activity, package status, and anticipated delivery schedule

●Operated continual incoming call line; routed and transferred to inner and outer office extensions

●Customer complaint management and resolution

●Redirected customers to appropriate agents for specialized package transfers and processing

●Submitted vendor concerns to nationwide UPS Service Centers

●Screened corporate concerns for UPS service failures

●Calculated time-in-transit for international packages

●Routed damaged and lost package concerns to appropriate departments for processing

GUILFORD COUNTY, High Point, NC

Administrative Assistant, 2002-2009

●Provided Social Services program descriptions and requirements to intake clients

●Pre-screened eligibility of clients and informed clients of service activity, status and recertification periods

●Formatted, updated, printed and distributed community services information pamphlets

●Manipulated Social Services specific One Case System in order to direct clients and workers on best steps for case management

●Operated 4-line switchboard, maintained client files and distributed client and worker correspondence

●Oversaw client complaint management

●Maintained and updated program descriptions and regulations

●Office Support for eight In-Home Aide Social Workers, sixteen Aides, and two Blind-Services Workers

●Recorded and budgeted inner-office expenses

ADDITIONAL EXPERIENCE

OPTION ONE, Greensboro, NC Legal Secretary, 1996-2000. Drafted legal documents, (Complaints, Answers ect.) Legal research (specific to cases) and transcribed depositions and attorney case notes. Initial contact/ case information and appointment scheduling. 3-line phone. Maintained hourly record of hours worked on each case(both for the attorneys and the paralegals). Submitted and processed legal documents to the court. Inner-office correspondence and reception for walk-ins and appointments.

GUILFORD TECHNICAL COMMUNITY COLLEGE, Jamestown, NC

Office Assistant, 1994-1996. 92

EDUCATION

LAUREL UNIVERSITY, High Point, North Carolina, Counseling

HIGH POINT UNIVERSITY, High Point, North Carolina, Counseling Major

HIGH POINT CENTRAL, High Point, North Carolina, College Preparatory High School Diploma

Honors Society

Future Homemakers of America

Drama Club

Debate Club

JOB SKILLS

Typing: 55 WPM; Microsoft Office Word, Excel, Power Pont, Epic, Data Entry, Transcription, Switchboard, Fax and TDM, Complex Duplication and Binding, AS400

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