Customer Service Manager
Resume:
Brenda L. Robins
Lawrenceville Georgia 30044
******.******@*****.***
Objective
Proactively pursue personal and organizational growth by providing the highest level of customer service and ensuring impeccable client relations. Integrate educational and work experience to promote individual and team goals via knowledge sharing, identifying issue trends and eliminating barriers to client satisfaction.
Professional Work Experience
Physician Jobs.com 2011-Present
• Researched and Credentialed past and present providers to NCQA standards.
• Organize, created, and maintain legal folders and Specific Binders for all providers and client contracts.
• Researched past provider payroll, and organized and created specific Binders for quick review
• Weekly reconcile provider payroll, create invoices for direct deposit or weekly mailings.
• Consistently assist management with aging account receivable invoices and statements.
• Assist, educate, and guide recruiters and marketers in all aspects of the internal initial credentialing process.
• Mail, fax, and provide critical correspondence with potential providers and clients.
• Registered to become to the NPDB agent for Physician Jobs .com
• Provide excellent customer service both internally and externally.
Humana 2008-2011
Credentialing Specialist
• Research and consult for Provider participation verification.
• Maintain high quality standards for Policies and procedures
• NCQA and JCAHO requirements and accreditation standards
• Credentialing Files (content, documentation)
• Credentialing Committee preparation
• Monitor the expiration dates for State License, DEA, DPS, Malpractice Insurance, Board Certifications, ect.
• Maintain database updates in multiple states to obtain, prepare, and recredential providers or decredential the providers.
2005 – 2008
Claims Research Analyst
• Successfully completed 4 months Claims research training with perfect attendance.
• Successfully process claims for all markets. Strategically specializing in the Ohio, Florida and Designated markets.
• Resolved high priority, business impacting issues for Children’s, Standard Register, Health Alliance, Gambro's and P&G via successful completion of multiple High Profiles internal projects.
• Investigate, identify and eliminates issues to resolve denied provider claims by understanding National insurance contracting.
• Awarded Humana’s Star Award for excellence and dedicated service to Health Alliance.
• Professionally initiates meetings with other departments to achieve understanding to complete tasks.
• Demonstrate strong team ethics with a professional but friendly attitude.
• Served as New Hire mentor for the two previous training classes. Provided detailed assistance within the nesting time period and as associates acclimate to their roles as effective team members.
• Continue to exceed production requirements.
Oakley Square Eye Associates 2002-2004
Optician
• Verified all insurance plans and claims information.
• Record keeping for patient and billing purposes.
• Maintained and updated insurance information.
• Processed all health insurance claims manually and online.
• Responsible for scheduling appointments based on the customer’s needs.
• Perform pre- examination procedures and testing.
• Assist patients with choosing eyewear to enhance their appearance.
• Assisted the Dr.’s with additional types of pre-testing.
• Provided patients with Rx instructions on using eye drops and eye irrigations.
• Assisted the Dr.’s with "Duping", measuring and polishing Contact lenses.
• Responsibility of all patient I&R instructions.
• All labs ordering for glasses, contacts and distribution.
Curves 2002-2002
Operations- Manager
• Supervised full time and part time employees.
• Hired and trained staff members.
• Developed training schedules for membership exceeding 650 members.
• Responsible for daily, weekly and monthly information pertaining to all bank reconciliation.
Hyde Park Optometrist 2000-2002
Assistant Optician
• Responsible for scheduling appointments based on the customer’s needs.
• Perform pre- examination procedures and testing.
• Assist patients with choosing eyewear to enhance their appearance.
• Assisted the Dr.’s with additional types of pre-testing.
• Provided patients with Rx instructions on using eye drops and eye irrigations.
• Assisted the Dr.’s with "Duping", measuring and polishing Contact lenses.
• Responsibility of all patient I&R instructions.
• All lab ordering for glasses, contacts and distribution.
CoStar Group Inc. 1998-2000
Senior Research Analyst
• Responsible for overseeing the database for particular territories within our distribution area.
• Investigating and updating the company’s national database.
• Analyzed information supplied by other companies through internet searches.
• Verified information for business productivity.
Anthem Blue Cross\Blue Shield 1995-2000
Licensed Sales Agent
• Licensed agent responsible for selling to the over and under -65 markets in three states.
• Offering Triple option plans, which include Anthem Senior Advantage, Medicare Select and Medicare Supplement policies.
• Interpreting healthcare guidelines put in place by the Health Care Finance Administration.
• Maintained product/technical knowledge for over 65 Health policies.
• Coordinated and trained inside sales customers’ representatives and telephone agents.
State Farm Insurance 1993-1995
Office Administrator
• Responsible for a broad spectrum of office duties including typing, filing, record keeping, customer contact.
• Banking, operating State Farms ECHO systems.
• Provided initial insurance coverage quotes, and reconciling premium transactions.
Len Crafters 1987-1993
Assistant Manager
• Responsible for assisting the manager with hiring and training of new personnel.
• Assisted patients and customers with every facet of choosing eyewear, managing scheduling and operations.
• Responsibility of all patient I&R instructions.
• All ordering of glasses, contacts and distribution.
Education
Xavier University
• Major: Business
Southern Ohio College
• Major: Optical Science
Personal References
Kelly Guthrie– Manager
640 Eden Park Drive
Cincinnati, Oh 45202
********@******.***
Donald Jordon – Cincinnati Police Officer
2802 Greenbreyer Ave.
Cincinnati, Oh 45237
Home 513-***-****
Cell 513-***-****
Barbara Rothan-Front Line Leader
640 Eden Park Drive
Cincinnati, Oh 45202
*******@******.***
Contact this candidate