Customer Service High School

Sheila Matthews

***** ****** • Detroit, Michigan 48235 • 313-***-**** • E-mail ******************@*****.***

Well trained, high producing Telephone Representative seeks challenging position with your company.

SUMMARY OF QUALIFICATIONS

Multiple awards for outstanding quality work with 100% proficiency.

Over 10 years experience in Customer Service.

Able to apply insurance and medical terminology.

PROFESSIONAL BACKGROUND

Snelling Staffing, Southfield, MI 03-02-2011-03-08-2011

Service Data Entry Clerical Customer

Contacted new and existing member for AAA Life Insurance Company via phone to verify life insurance enrollment information. Created and updated files based upon the information received.

Strategic Staffing Solutions, Detroit, MI

National Provider Identifier Analysis for BCBS of MI 05-05-2008-12-31-2008

Contacted providers via phone to collect NPI mapping information.

Worked with the provider staff to answer inquiries via phone or written correspondence.

Determined if any new provider PINs needed to be created or if provider PINs needed to be inactivated.

Monitored and analyzed NPI crosswalk error reports and initiated a resolution.

Wisconsin Physicians Service, Madison, WI 061***-**-****

Medicare Beneficiary Telephone/Written Representative

Received and respond to a wide range of telephone and written inquiries from customers on a pre and post-claim processing basis. Deal tactfully and persuasively with internal and external customers; face to face contact with beneficiaries in the beneficiary walk in area. Analyzed and resolved telephone and written inquiries which included; providing clarification, information, and education to members, claim status, claim reopening and adjustments, verification for overpayment situations, updated members addresses, resolving complaints and concerns in a timely manner; provided correspondence explaining coverage or benefits, facilitating claims resolution through contacts with members and internal departments i.e. The Complaint Screening Department, Appeals, Medicare Secondary Payer Department, and referred misdirected call to the proper departments.

PC Skills: Training: Medical Terminology

Microsoft Office Medical Terminology

Prism HIPAA Awareness

Internet Outlook Total Quality Environment (TQE)

Facets Ethics Training

EDUCATION

Win Program, Louisville, KY

Clerical Training. September 1972- January 1973.

Jefferson Community College, Louisville, KY Basic Curriculum Summer, 1971.

Kentucky State University, Frankfort, KY Home Economics January. 1971

Central High School, Louisville, KY High School Diploma received. September 1967- June 1970.

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