Customer Service Sales
Resume:
Deborah Myers
**** ******* ***, ****** ** *****
E-Mail ************@***********.***
Summary Experience
Heavy experience in claims management with emphasis in production, workflow, recovery and claim training; experienced contract management, excellent communication that create win-win solutions; professionalism in face to face and telephone interaction; proven track records in administration, customer service/relations, and general management, self motivated team leader, effective liaison with strong interpersonal skills, HR hiring practices and procedures, IDC-9, Medicare, CPT, self/fully funded, TPA, Managed Care, and COBRA
Areas of Expertise:
Team Lead
Administer group and individual benefit plans (HMO, PPO, POS)
Work effectively with the Healthcare industries (15 years experience)
Knowledgeable of Benefit Programs & Administration (TPA)
Claim Subrogation
Coordination of Benefit between carriers
Advantage Life & Financial Services (2/2010-present)
•Conduct one-on-one financial assessments while identifying customer needs recommend the right solutions and products
•Address questions/objections and develop customer relationships through active profiling.
•Improving customer service based on client feedback through the development of new policies and procedures.
•Answered customer’s enquiries using the standard guidelines.
•Analyzed the sales targets and met it under a predetermined deadline.
•Process policy updates and changes
•Order forms, applications and requests
•Handled all investment forms and inquiries regarding distributions of funds after termination, hardship, general withdrawals and payroll deductions.
Professional License Classes and Training 2009-2010
•Life/Health (Illinois Producers) 2009
•031(Loan Originators) 2010
TriZetto Group 2002-2008 / Senior Claims Analyst /Managed Care Operations
•Operated as a senior claims adjustor in managed care operations
•Subrogation and coordination of benefits between carriers
•Initiate & oversee dispute and overpayment process
•Ensured all aspects of operational contract implementations are completed accurately and on time
•Negotiate contracts and other understandings on behalf of the company
•Investigates and resolves issues related to contract administration and claims adjudication
•Follow up with case mangers and provider
•Work closely with registered nursing staff on referral process
•Repricing for Humana.
•Production 250 claims per day
•Remote (work from home) for 4 years
Professional Benefit Administrators 1998-2002 / Team Lead Claims
•Manage, retain and service small to medium size account providing consultation to client
•PPO, HMO, individual and group claim specialist
•Bill review, provider appeals, assistant to account rep
•Claim adjustments and overpayments
•Billing and claim auditing
•Manage Incoming and outgoing referral process.
Travelers Insurance 1994-1998/ Business Support & Administrative Customer Service
•Assist with recruited and develop business opportunities
•Manage product presentation
•Develop strong relationship with vendors & marketing associates
•Provide sales support & set up for sales presentations and product sampling
•Claim administration & workflow management
•Underwriting support.
Education
2012 Columbia College/Communications, Chicago, IL
2008 ECO 5303 Managerial Economics /Cert
2009 Illinois Producer License (Life, Health, Annuities
2010 Group Health License
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