Customer Service Medical
Resume:
Tricia Frost
Johnsburg IL ****1
**********@*****.***
______________________________________________________________________
Summary
A highly motivated professional with 15 + years of Healthcare experience, in addition to providing team leadership and management. My ability to multitask, exceptional communication, attention to detail and organizational skills allow me to recognize opportunity and seek new challenges. I look forward to utilizing my extensive service and leadership skills in alignment with the goals of a world class business.
Experience
Stay at Home Mom, Johnsburg, IL 2009-Current
Independent Sales (Scentsy) March 2010- Current
Mchenry Community College (Phlebotomy degree, January-April 2011)
Bartending (Tammy's Pizza)April 2010- January 2011
Trustmark Life Insurance, Lake Forest, IL (August 2001- March 2009)
Health Fraud Investigator/Specialist, The Sentinel Group (SIU) April 2005- March 2009
Analyze, review, and investigate cases to identify patterns of fraud and abuse.
Thorough assessment and investigation on Insureds claims, Medical records, providers/facilities and appeals in accordance with ERISA and state regulations
Utilize resources; FBI, State Departments, PFG manuals, CPT coding, Medical Terminology and in-house/off-site providers,
Handle/Update Appeal procedures/process in accordance with state laws
Manage/train and coordinate with off-site vendors on all medical reviews, billing and budget
Insured/Provider educator on billing(s), claim filing and insurance processes
Insured/Patient advocate
Manager, Starmark Administration (August 2001- April 200*-****-****
Provide leadership, support and methods to motivate and guide the Administration unit.
Recruit, hire, develop, train and retain talented Administration personnel
Examine the underwriting of life and disability coverage
Knowledge of small group insurance laws/regulations
Adapt/modify current procedures/work-flow for effective business results
Developed system and procedures for tracking all supply orders (internal and external) to enhance expenses for Budget
Project Management Committee
W.W. Grainger 1999-2001
e Business Group- Lincolnshire IL (February 1999-May 2001)
Customer Care Coordinator
Provide leadership to coordinate the success of Customer Care.
Selected to create and launch Customer care to support Grainger Integrated Supply’s Fortune 500 clients, Procurestar and e Business divisions-(FindMRO, TotalMRO and MROverstock)
Recruit, hire, develop, train and retain talented Customer Care personnel
Manage and facilitate multichannel customer communications (web, e-mail and phone) to comply with preliminary goals and ensure timely responses for the customer
Monitor service levels, procedures, feedback and recognition of Customer Care Agents
Trustmark Life Insurance- Lake Forest IL 1994-1999
Medical Underwriting Assistant (August 1998-February 1999)
Provide assistance, support, prepare rates on new business groups and maintain insurance renewal records for Senior Underwriters to quote annual premiums.
Investigate medical and long term disability claims
Accounting Assistant, Group Premium Auditor (January 1994 -August 1998)
Process premium audits, monthly reconciliations, maintain eligibility and provide customer service to all internal and external customers.
Control refunds and delinquency notices
Completion of daily electronic claims correction
Education
Mchenry Community College, Phlebotomy- Mchenry IL
Gateway Technical College, Court Reporting- Kenosha WI
College of Lake County, Criminal Law- Grayslake IL
Warren Township High School- Gurnee IL
Professional Development
Phlebotomy, 100 hours, 150 draws. Clinical through Centegra Hospitals. April 2011, ASCP. Medical Terminology, Proficient in MS office. Keyboard, 80WPM
REFERENCES
Nadine Clausen- HR Assistant Director * Trustmark * 847-***-****
******.*******@************.***
Kim Gembara * Health Fraud Investigator * The Sentinel Group/Emdeon * 847-***-****
********@******.***
Fred Daniels * Sr Management, * The Sentinel Group/Emdeon * 847-***-****
********@******.***
Contact this candidate