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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Tenth AvenueChickasaw, Alabama Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEMy objective is to obtain a full-time position with a growing and forward thinking company. I am reliable, hardworking with expertise in customer service, complaint handling/resolution, and customer relations. I have exceptional organization skills with strong attention to detailsSKILLS*Customer Service Skills *Computer proficiency *Certified in 10-key*Type 50 WPM *Leadership experience *Communication skills*Fast Learner *Hard Working *Efficient problem solver*Results-oriented *Accurate Data CaptureEXPERIENCEMolina Healthcare Provider Services/Claim Representative Virtual03/2020-02/2022Answered inbound provider calls nationwide for subscribers of Molina Healthcare in NY, MS, CA, IL, OH medical insurance plans. Answered inbound calls from hospitals, medical practices and substance abuse/mental health facilities to answer medical policy insurance inquiries.Provided up to date benefit quotes stating copay, deductible, coinsurance, and out of pocket values for specific medical procedures.Researched cpt codes for various medical procedures giving the accurate benefit quote and supporting medical policies that may influence medical claim approval. Reviewed medical policy bulletins if applicable for providers with claim denials.Reviewed and submitted adjustments when claim denial errors are discovered. Explained provider offsets/refunds to providers when payments are recouped for claims paid in errorCVS Pharmacy Benefit Verified Representative Virtual10/2018-03/2020Answer inbound calls from pharmacists and staff regarding denied claims and checking eligibility.Assisted member with issue of filling medication at pharmacy.Assisted member with new order and refill through mail orderAssisted member with issue of not receiving or over charge of mail orderAssisted member with check coverage and cost of medicationSent request to providers for medication refillsConduent, Inc Tech Support/Senior Support Virtual04/2016-10/2018Answering inbound calls assisting with iOS/macOS technical issues regarding their apple devicesAssisted customer with starting and managing apple id accountsAssisted member with locked or lost devicesManaged high call volume with tact and professionalismHandle escalated calls and provided senior support to tier 1 representativesAuto Injury Solution Data Entry/ISL Claim Processor Daphne,Al01/2013-04/2016Process over 25 auto claims daily and data captured over a 800 line daily.Organized medical billing/invoice data, data captured all charges and prepared accounts for adjuster.Contacted customers to give and receive missing documents for claim to be processed Made outbound calls regarding insurance verification or inquiries regarding billing codes for medical providersEDUCATIONSatsuma High School Satsuma, Alabama - HS Diploma08/2000- 05/2004Remington College Mobile, Alabama - Medical Assistant/Billing Certification04/2005-09/2006 |
