Customer Service Representative

P.O Box ****** Mario Diaz

***********@*****.***

Duluth, GA 30095 917-***-****

*************@*****.***

A disciplined and focused self motivated professional with over 20 years

experience in customer service, health insurance and problem solving.

Knowledgeable through long practice in achieving visions and goals

expeditiously; diverse multitasked independent thinker that has mastered

fulfilling the customer's needs.

SPECIAL SKILLS:

Bilingual, excellent communication and interpersonal skills, self

motivated independent thinker, knowledgeable in health insurance and

plans, Cobra, medical terminology, ICD 9, CPT 4, HMO, POS, PPO, HIPAA and

FDCPA compliance, data processing, Microsoft Office, Ontario FACS.

EXPERIENCE:

8/12- Present Bankers Life and Casualty

Agent

. Contact potential prospect, set up appointments to review how they are

set up in 4 areas.

. Determine their needs as far as insurance and finances and make

recommendations.

. Review all present insurance policies to be sure they are still

working as planned.

. Assist prospect on acquiring any necessary coverage needed.

1/04 - 2012 Hollis Cobb & Associates - GA

Collector/ Bilingual Insurance Specialist/ Bilingual Patient

Account Representative

. Contacted debtors, on past due accounts, courteously and

professionally to request and obtain payments.

. Reviewed and analyzed debtor's credit records to determined

availability of funds for possible payments.

. Negotiated settlements and arrangements for resolution of balance in

full on all accounts.

. Examined insurance payments received were accurate according to

contract and state prompt pay laws.

. Assessed insurance claims status, re-filed corrected claims including

appeals.

. Handled bilingual customer service, making over 200 calls

per day and negotiated self-pay discounts.

. Analyzed, appraised, reviewed and adjusted patient hospital

accounts and financial assistance applications.

11/03 - 12/05 Saladmaster/Exeter Group - GA

Sales/Health and Nutrition

. Educated consumers on health and contributing factors to illnesses and

food preparation methods.

. Sales representative and bilingual presentation specialist.

1/01 - 11/03 Mario Diaz Dance Revue/Mambo with Mario Dance

School - NYC & GA

Founder/President/Artistic Director/Up-sales

Representative

. Coordinated and created concepts and choreography for the

dance company, artist and performers.

. Developed client list and acted as liaison between

artist/client, venue and Dance Company.

. Coached and instructed students, professional dancers and

dance company members.

4/94 - 1/01 United Wire Metal & Machine, Health & Welfare Fund - NYC

Claims Examiner/Bilingual Customer Service Representative

. Verification of policies and coverage for claim

processing and consideration.

. Confirm validity, accuracy and completeness of claim form.

. Responsible for accurate and timely adjudication of over 100 medical,

lab, x-ray, surgical, anesthesia,

psychiatric, vision care, disability, workmen's compensation, appeals,

and hospital claims per day.

. Primary bilingual customer service representative for members and

negotiated bills for claimants/members.

. Translated for union delegates and members, troubleshooter, data

processer, research and clerical duties.

P.O Box 958072 Mario Diaz

***********@*****.***

Duluth, GA 30095 917-***-****

*************@*****.***

1990 - 1994 Self-Employed - NYC

Performer/Dance instructor/Choreographer/Personal

coach/Percussionist

. Worked as a dance instructor and personal coach for various dance

schools.

. Freelance choreographer for world renowned artist and concert tours.

. Performed as a dancer and percussionist for various Latin artists.

1989 - 1990 Union Labor Life Insurance Co. - NYC

Claims Examiner/Bilingual Customer Service Representative

. Verification of policies and coverage for claim

processing and consideration.

. Processed over 90 health insurance claims per day from

claimant inquiry to final approval.

. Responsible for all bilingual calls pertaining to customer

service issues regarding claims and benefits

for claimants/medical facilities.

. Review appeals from members and medical providers.

1979 - 1989 1199 National Benefit Fund - NYC

Claims Examiner/Bilingual Customer Service Representative

. Began as a file clerk and was later promoted to

claims service representative in 1980, then to

claims

examiner in 1984.

. Confirm validity accuracy and completeness of claim form.

. Verification of policies and coverage for claim

processing and consideration.

. Processed over 80 medical, lab, x-ray, and surgical claims per day

from claimant inquiry to final approval.

. Managed all bilingual customer service for members, including trouble

shooting all claims issues, workmen's compensation, benefits and

appeals.

Contact this candidate