Customer Service Representative

Diane Robinson-Newman

*** **** ******* ******

Clifton Heights, PA 19018

484-***-**** (home)

484-***-**** (cell)

Objective

I have been in the Insurance Industry for over 30 years. I have acquired specialized skills, knowledge and abilities, which resulted in my upscale climb in the handling of Life and Health Insurance.

Work Experience

01/10/05 to 10/30/2009 Independence Blue Cross/ Philadelphia, PA

Supervisor (Government Programs Operations)

Supervises all aspects of Local Claims processing. Ensures all Local Claims are processed accurately and timely. Managed production staff's performance on a daily basis. Handled all administration functions related to the Unit efficiently. Ensured that all individual, team and divisional goals are achieved.

10/2002 to 01/10/05 Independence Blue Cross /Philadelphia, PA

Team Consultant (Dedicated Accounts)

Organized, investigated, reviewed handled all claims inventory for my assigned specialized group. I coordinated, managed, engaged and interpreted the planned benefits as designed by the group. I monitored and controlled the call center. This included side by side monitoring sessions, reviewing call monitors, updated the Team Representatives monthly staffing. Reviewed the call center and claims examiners monthly Quality Scoring. Developed training sessions for the less experienced Team Service Representative. Technical administrator for the Magellan Referral process. Assisted the Groups Marketing Representatives at the open enrollments and benefit selections. Reported directly to the Manager.

10/98 to 10/2002 Independence Blue Cross /Philadelphia, PA

Senior Team Service Representative (Dedicated Accounts)

Processed simple, sensitive and high dollar claims. Monitor investigation of systematic reports and facilitated the adjudication of problem claims. Trained new Representatives. Serviced telephonic and written inquiries from subscribers and providers. Ability to handle Unit operations with little or no supervision. Strive for Unit Accuracy in handling and processing of claims. Handle supervisor telephonic issues. Audit of claim accounts as requested by the group, providers and members. Acts as a liaison between the group administrator and Independence Blue Cross. Assist the Marketing Representative with complex group issues involving benefit interpretation and updating the benefits when requested by the Group Administrator. Technical administrator for the Magellan referral process.

10/97 to 10/98 Independence Blue Cross/Philadelphia, PA

Unit Leader of Claim Services

Organized and controlled the flow of work within the unit, compiled data and completed reports for the inventory. Provided technical assistance to all examiners. Resolved telephonic and written inquires for internal and external customers. Served as an information and process resource for management and functional areas.

9/93 to 10/89 Independence Blue Cross/Philadelphia, PA

Professional Claims Examiner

Processed claims based on corporate guidelines. Performed research and investigative duties related to claims processing.

Education

9/79 to 6/80 Philadelphia School of Office Training, Philadelphia, PA

Associates Degree in Business Administration

9/65 to 6/69 John W. Hallahan Catholic Girls High, Philadelphia, PA

Academic Diploma

Seminars

Medicare Processing and Payment, Medical Terminology, Telecommunications Skills and Writing for Work, Dealing with Upset Customers, Windows 3.1, Career Building, Associate Development Program, Medicare Computer Based Training, Responsive Writing Plus, Dealing with Difficult People, Giving and Receiving Constructive Feedback, Correcting Performance Problems, Personal Strategies for Navigating Change, Influencing for Win-Win Outcome, Team Grammar

Technical Skills

CIS, PlanMate (processing and adjustments) for both professional and facility PPO, CMM and OOA, ITS, INFO, Oscar (processing and adjustments) for both professional and facility PPO, CMM and OOA, Customer Service (Members, Providers and Group Administrators), MEDCO, FAF, PQC100

Interests

Junior Achievement Consultant, Modeling, Dance Instructor, Singing, Acting, President of Drama and Fine Arts Guild, President of the Women/Young Ladies Department for the B. M. Oakley Memorial Temple, C.O.G.I.C., President and CEO of the Diamond and Pearl Ministry, Co-President of the Youth Department, Bible Institute and New Members Instructor

REFERENCE FURNISHED UPON REQUEST

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