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Click here or scroll down to respond to this candidateCandidate's Name
3409 Santa Rita Lane, Land O Lakes, FL 34639 ~ PHONE NUMBER AVAILABLE ~ EMAIL AVAILABLE Professional Summary:Customer-focused professional with 15+ years of experience nurturing client relationships while exhibiting a high level of professionalism and a client-focused approach that is responsive, proactive, accountable, and reliable. Participates in strategic initiatives identifying and implementing best practices and operational efficiencies. Strong work ethic, problem-solving, communication, interpersonal and teamwork skills. High degree of self-motivation, proactiveness, forward thinking, and assertiveness to manage customer expectations as well as driving internal collaboration. Work Experience:Claims Adjuster II, Elevance Health, Tampa, FL October 2018 CurrentApply claims management experience to execute decision-making to analyze claims exposure, plan the proper course of action, and appropriately resolve claims.o Files and processes provider insurance claims, while ensuring the coverage and payment amount for each claim. o Strong analytical, problem-solving, results-driven, and solutions-focused skills. o Professional telephone etiquette and excellent oral and written communication skills. o Interact extensively with various parties involved in the claim process to ensure effective communication and resolution.Document all interactions, research, verifications, and other claim-related information. o Ability to prioritize workload to meet deadlines. o Customer focused personality and a desire to help people. o Answers questions regarding the status of pending claims from claimants, policy holders, and medical providers. o Handle claims consistent with clients and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements.Ensure payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes.o Sends payments to providers as well as hospitals for covered procedures. o Consult with attorneys regarding litigation management, settlement strategy, and claim resolution. o Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process.Customer Service Representative Elevance Health, Tampa, FL October 2013 September 2018Utilized an electronic health record and communication methods to ensure accurate and complete information was shared and contributed to the coordination of patient care. o Managed care Medicare plans, and Dual Medicare and Medicaid plans. o Effectively managed high volume of incoming calls, providing exceptional customer service to ensure a high level of satisfaction for patients, practices, and providers.Exceptional customer service, active listening, and verbal and written communication skills. o Assisted members by dealing with a wide range of issues including billing, primary care physician changes, as well as address changes and reviewing claims.o Possesses a positive personality with a desire to understand concerns, build trust, and show care for every customer.Identified and addressed caller questions and concerns, resolved issues when possible and routed requests and messages to appropriate provider and support staff.o Maintained accountability for accurate data entry in the electronic health record and maintained patient privacy and security as outlines by HIPAA.Concierge Specialist Freedom Health Inc., Tampa, FL October 2007 February 2009Ensured that every customer received personalized assistance, guidance, and support. o Excellent interpersonal and communication skills, with the ability to engage effectively with customers from diverse backgrounds.o Helped with billing inquiries, primary care physician changes, address changes, and reviewed and documented claims.Assisted members with inbound/outbound calls with their Medicare replacement plans. o Awarded Employee of the Month several times and became a team leader for special projects. o Experience with writing and communicating effectively within multiple communication channels including, telephone and email environments.Customer Service Specialist Aetna Health Inc., Tampa, FL September 2006 February 2007Provided assistance, answered inquiries, and resolved issues to guarantee the best possible customer experience. o Handled inbound client requests instantly and successfully. o Assisted clients with exploring on the web gateways and apparatuses. o Resolved client grievances and raised issues depending on the situation. o Ability to collaborate effectively with colleagues and other departments.Developed a comprehensive understanding of Aetna products and services to provide accurate information to customers. o Delighted members with prompt, professional, and courteous assistance. o Kept and elevated degree of impressive skill and compassion in all collaborations. o Displayed empathy and patience when dealing with members to ensure a positive experience. o Proven ability to analyze issues and fine effective solutions. o Received Customer Service Representative of the Month award. Education:St. Petersburg CollegeSkills:Communication Empathy Collaboration Multitasking Problem Solving Patience Product Knowledge Adaptability Conflict Resolution Prioritization Active Listening Customer Service Liability Insurance Claims Time Management Analytical Skills Data Analysis Auto Claims Computer Literacy Insurance Coverage Investigating Microsoft Office Negotiation SkillsSettlement Authority Customer Relationship Management Claims Handling Detail-Oriented Property Claims Empathy Compliance Litigating Written Communication |
