Customer Service Medical

CUSTOMER SERVICE/ADMINISTRATOR

With *+ years of experience in Administration and Clerical

2+ years in Medical & Dental Adjudicator

Strengths and skills include the following:

Enthusiastic, energetic and honest

Adept at handling various administrative and clerical functions

Efficient in Microsoft Office & Windows XP

Ability to multi-task and effectively manage time and competing priorities

Friendly and reliable with excellent communication skills

Works well in a team setting and independently

Computer skills- Able to type 55 to 65 WPM

Familiar with various office systems and web resources

Works well in a fast paced environment

Exceptional data entry skills with great accuracy/attention to details

Professional handling of customer services enquiries (Client Communications)

BUSINESS EXPERIENCE

DESJARDINS FINANCIAL SECURITY JULY 2006 – MAY 2011

Health & Dental Claims Assessor, (2007-2011)

Evaluated health (medical) and dental claims to validate payments

Calculate benefit payments and approve payment of claims within a certain monetary limits and according with provisions of the policy, provincial laws and administrative guidelines

Preparing daily reports (such as inventory, documents files, etc)

Updating and correcting provider information on office systems (i.e DEVA, EVA, ClaimFacts)

Assessed claims for fraud and properly documented all findings in the system

Reviewed claims for clients to ensure compliance with internal and external regulations/ Group Benefits administrator

Examined, assessed and reviewed pre-determinations and major restorative dental claims

Processing and maintaining reports/correspondence for Travel Claims

Handling private and confidential information with high degree of confidence and professionalism

Provided written and verbal communications to clients via call centre or phone

Adjusting benefits enrollments, coverage, dependents and beneficiary info/ Assisting accounting dept and cheques receiving and retrieving

Discussed complex and diverse situations with the dental and medical consultants

Processes volumes of medical and dental claims with great accuracy

Administrative Clerk (Intermediate), (2007-2008)

Providing support to staff/coworkers, maintaining office equipment and invertory

Mail room clerk- assisting in opening incoming mail & parcels

Organized any Explanation of Benefits & cheques that go out to the insurers, and filed records in order

Tracked Travel/Out of Country claims on system (ClaimFacts) and inputted medical notes for member/family, as well as updating information for the assessors

Ensured that any Canada Post Cheques Returned are logged into the system for other administrators

Accurately logged all Direct Deposits information into the systems

Updated any or all information as per request of member, whether address change or Direct Deposit account changes, email address, etc.

Support Clerk, (2006- 2007)

Sorted Claims from the Special/Solo/Individual Groups

Organized reports using Microsoft Excel and Word/Accounts payable clerk

Filed any or all Special Authorization claims

Distributed claims among the assessors/ Filed claim files for the assessors

Ensured any important incoming information is given to the Administration and Group Claims Departments

Informed the Team Leaders about the organization of the claims and the claims counts for the day/week and month

Summer Student, (July 2006- Sept 2006)

Data entry on Health and Dental Claims- ClaimsFacts/EVA/DEVA

Filled in data for clients using the Direct Deposit option

Updated the Student Status reports for the clients/assessors

Made and Mailed out notices for missing information for New Groups

Scanned New Groups information in the main database

Wrote correspondence to clients with missing data information in their files

Supported the assessors in retrieving any information on missing claims

EDUCATION

CDI COLLEGE OF BUSINESS, HEALTH & TECHNOLOGY, MARCH 2006- DEC 2006

(Now Everest College of Business, Health & Technology)

Graduate – Business Administration

Completed a accelerated course to earn a Certificate/Diploma in Business Administration

Averaged over 85% in Microsoft Excel and Microsoft Word

Top of the class in Keyboarding and Communications Skills

Completed & excelled in courses such as Simply Accounting, Human Resources, Economics, Business Planning, Finance

Also completed activities such as public speaking, and business organization

LOMA 280- Independent studies for LOMA 280 with Desjardins (working towards a CIP)

CENTENNIAL COLLEGE, Social Worker 2002- 2004

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