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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Ridge TrailGoodlettsville, Tennessee Street Address
PHONE NUMBER AVAILABLEAccomplishmentsCurrent PositionUnited Health Group as an Associate Claims Representative, responsible for handling incoming healthcare claims ensuring a high level of customer service and maximizing productivity by processing claims accurately, the first time..Aetna Med D Specialist 2015-2016 Escalation Specialist, CVS Caremark Care Rep Aetna Med D Specialist 11/01/2015- until Now My Job include and not limited to having excellent communication skills, including a strong command of the English language and the ability to clearly articulate program details to customers over the telephone, managing Medicare D and Commercial AccountsFujitsu America Inc. Call Monitoring and My Skills are Proven analytical skills and attention to detail,Ability to effectively define issues, collect data, I have Ability to interpret and integrate state Medicaid and Medicare guidance into applicable processes Proficient in analyzing specific types of moderate to complex claim transactions and proven experience in delivering accurate and precise results Excellent verbal and written communication, demonstrated ability to document and present concepts in a clear, concise and logical manner2015 Team Lead, Flextronics/Solectron Global IBM- 2006-2011 Trainer, Flextronics/Solectron Global IBM 2003-2006 Escalation Technician, - Flextronics/Solectron Global 1999-2003 ExperienceProficient to advanced PC skills, including MS Windows-based applications, Also trained to manage Aetna Medicare Part D and Mail Order services Escalation Specialist Fujitsu America Inc., Escalation Specialist May 2011-November 2015 (4 years 5 months) Duties include technical support for product hardware and operating systems of all Fujitsu America Systems.Support for mobile computer products and accessories via phone and email.Serve as liaison for customer issues in relation to repair depot, customer satisfaction, warehouse, and other Fujitsu America Groups.Team Lead Feb 2006-May 2011 (5 years) Flextronics/Solectron Global IBM Duties include leading a team of 15-20 techs with the responsibility of repairing and Shipping laptops, while adhering to company policies 5S standards Trainer April 2003- Feb 2006 (2 years 8 months) Flextronics/Solectron Global IBM Duties included training all new hires, in SOP which ranged from company policy, repair, parts ordering and ESD procedures Escalation Technician August 1999-April 2003 (3 years 8 months) Flextronics/Solectron Global Duties included trouble-shooting, repairing and parts requisition for IBM laptop Computers. In addition I was assigned to work on special problem units and ensuring that these units went out with the proper operating systems installed and shipped back to customers in a timely manner.Professional SummaryExpert communicator with 10+ years of experience Strong in teaching, and facilitating skills for diverse student, professional, and general audiences Extensive involvement in all levels of relationship building report, Proven ability to manage multiple projects while meeting challenging deadlines Customer Service manager with extensive experience directing busy call centers. Proven ability to increase Customer satisfaction as well as call volume per representative. Excellent leader with history of improving employee Morale and reducing turnover. Skilled communication and team motivation have resulted in fulfilling service goal and a strong team playerUnited Health GroupNovember 2016 until PresentMy daily routine is to Review, research, analyze and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits)Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool)Complete data entry for all daily documentation and communicate the status of claims adhering to reporting requirements Communicate through correspondence with members and providers regarding claim payment or required information using clear, simple language to ensure understanding Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors) Meeting and maintaining the performance goals established for the position in the areas of quality, production and attendanceCVS CaremarkNovember 2015-October 2016As an Aetna Customer Care Representative My duties were to manage at the first line of communication for our members. I worked in a call center environment and took inbound calls from our members, offering information and answering questions to help them make critical health decisions. This position is not a standard call center role, my interactions with our CVS Health members is a conversation; I was the person who listened when our customers call, and through their skills and knowledge voiced the solutions needed to help simplify their health care experience. Typical topics were including but not limited to: prescription refills, order status, verifying insurance coverage, and assisting with technical account challenges. Focusing on providing excellent customer service with empathy, while resolving the members questions on the first callFujitsu America Inc.,May 2011-Novembet 2015Duties include technical support for product hardware and operating systems of all Fujitsu America Systems. Support for mobile computer products and accessories via phone and email. Serve as liaison for customer issues in relation to repair depot, customer satisfaction, warehouse, and other Fujitsu America GroupsEducationRemington CollegeAssociates DegreeComputer Technology |
