Customer Service Representative

La Tanya L. Campbell

Home Phone: 562-***-****

Business Phone: 562-***-****

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

Qualification Summary: Savvy customer service representative with excellent organizational, computer and time management skills. Thorough understanding of Medicare guidelines, benefits and claims information. Extensive knowledge of HMO procedures, policies and claim processing.

Experience__________________________________________

08/2006- Present Member Service Representative Scan Health Plan, Long Beach, CA

Responds to member’s billing inquiries and discrepancies, provider changes, benefits and eligibility.

Recognizes problems and assists with resolutions.

Answers high volume phone calls with ease and professionalism.

Assists with priority calling projects and supervisor follow up issues

Maintains the Call Solution work list with an ETA of 24 hours for all call returns.

Assist members with premium inquiries, research and refunds and EFT processing and payments

Lobby calls for immediate queries placed in the corporate office

Familiar with HIPAA processes and procedures

Knowledgeable of Premium Billing guidelines per Chapter 4

Research and Resolution of Filed Grievances and CTM from CMS

2002-2006 Member Service Representative United Healthcare Systems, Cypress, CA

Responsible for providing quality customer service support to valuable members and providers

Assist members with benefit services, quotes and plan updates

Assist members with appeals and grievances

Provide quote eligibility and benefit information, research follow up with providers

Assist members in resolving claim issues

Mentor provider new hires

Secure Horizons customer Service Associates

1999-2002 Customer Service/Telephone Monitor Managed Health, Los Angeles, CA

Utilized professional phone etiquette while providing effective quality service to the general public, referral sources, clinicians and patients.

Created correspondence for patients, entered notes in the symphony system for various projects, assisted supervisor with duties as needed.

Education & Professional Development

Southwest College Los Angeles, CA

General Business Major

Computer Skills: Microsoft Office, Mainframe service system, 40 wpm, Outlook, data entry and ten key. Dedicated to the highest quality of work and the ability to learn quickly.

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