Senior Customer Service

CARL EDMUNDS

*** ***** ***. ***. **

Yeadon, PA. 19050

HM/Cell: 215-***-****

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

SUMMARY:

A licensed health care professional with multiple years of experience providing member services for various Blue Cross/Blue Shield and other health care providers. Very knowledgeable of Medicare, HIPAA regulations, and life insurance products. Licensed insurance agent with extensive experience in the marketing, sales and enrollment of insurance products. Experienced working in a high volume call center environment. Recognized for being ethical, dependable and have the ability to work within a team environment or independently.

EXPERIENCE:

AEROTEK – TRENTON, NJ July 2011-Jan. 2012

HORIZON NJ HEALTH

MANAGED CARE COORDINATOR

• To function and act as a liaison between members and providers while preparing case histories and reviews via telephone correspondence.

• Initiated concurrent reviews of activities for report analysis and data preparation for medical inquires.

• Provide correspondence to member and providers.

• Clarify benefits and courses of treatment, fees, and contract provisions via outbound and inbound calls.

• Managed the purchase of selected durable medical equipment.

• Performed procedural medical appropriateness interviews and data collection from providers and members.

• Maintained and gathered medical records and case histories for Quality and Grievance committee.

SNI COMPANIES – PHILADELPHIA, PA April 2011- June 2011

PHARMACEUTICAL SERVICE REP.

• Update and manage drug accounts for various medical facilities and clinics.

• Provide excellent customer service and order processing to numerous healthcare and doctor offices.

• Accurately process customer orders in an efficient manner to ensure customer demands are met.

CORPORATE CALL CENTER – BLUE BELL, PA August 2009 - March 2011

LICENSE HEALTH REPRESENTATIVE

• Coordinate, provide and deliver consultations for both Medicare eligible and Medicare members.

• Responsible for developing and presenting evaluations of various plans and plan types as well as providing plan explanations and descriptions.

• Enroll eligible candidates into their healthcare benefits in a high volume environment.

• Maintain a courteous, polite and professional manner during telephone calls with clients.

• Provide information about healthcare educational materials and services for members under 65.

BANKERS LIFE & CASUALTY – KING OF PRUSSIA, PA July 2008 – June 2009

INDEPENDENT LIFE AGENT

• Responsible for providing and delivering life, health and financial opportunities to clients.

• Modify, develop and present annual client evaluations and awareness programs.

• Generate leads and sales through cold calling and consultative sales approach.

CITY OF PHILADELPHIA – PHILADELPHIA, PA August 2006 – June 2008

CORRECTIONS AND DETENTIONS COUNSELOR

• Coordinate and monitor inmate or detainee movements, conducts counts and provides transport, and emergency response as needed.

• Monitored medication intake, supported and provided protective care in daily living setting.

• Oversee and monitor the activities of the inmates or detainees in dining areas and visitation areas.

FAIRMOUNT BEHAVIORAL HEALTH – PHILADELPHIA, PA Sept. 2000 – Nov. 2005

PSYCHIATRIC COUNSELOR

• Administer and monitor physician based therapeutic and group counseling sessions.

• Observance of medication intake, provide unit safety to clients with psychological and behavioral issues.

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