Customer Service

OBJECTIVE:
To acquire a full-time position that demands the full utilization of my professional skills and ••••• years quality experience.

SUMMARY OF SKILLS AND QUALIFICATIONS:
Expertise in ICD•••••, Advanced CPT, and HCFA coding, medical terminology, pharmacology, and basic insurance
Analyze and adjudicate medical, dental, Medicare, and Medicaid claims
Answer health care provider inquiries
Request and review patient medical records to determine contract benefits
Highest Production and Quality Standards met in all positions
Process paper and electronic claims
Data entry and front load claims for electronic process.
Update claims processing manuals to reflect changes in legislation and medical advancements
Current with subrogation and third party liability claims
Leader who is also able to be a valuable team player
Expertise in Microsoft Word and Excel

CAREER EXPERIENCE:
Home Health Aide
Brownsburg, IN
•••••current
Provide in-home ••••• hour care for disabled Alzheimers patient. Assist in all daily living personal care and activities. Also maintain security and health practices as up-to-date information becomes available. Administered medication and meals as prescribed and ordered by the doctors and dietician. Transport for physical therapy, medical visits, and occasional adult day care and interaction. Provide stimulation activities for brain and motor skills. Offer excellent love and care environment to ease the process for patient and family. Expertise in customer service and personal service.

Manpower
Indianapolis, IN
•••••
Office Administration/Special Project/Auditing
I worked with companies such as Eli Lilly, Citizens Gas, Indiana Department of Revenue, and Community Hospital. These were contract positions I completed successfully and returned to complete further assignments at the need of the companies.
Manufacture reports utilizing Excel and company specific software
Data Entry for a large utility company at high level of production
Maintained and audited files for high-profile accounts at large bank
Ran workmans comprehensive clinic for hospital employees
In charge of patient billing, work files, and protocol for infectious disease

Morris Associates
Indianapolis, IN
•••••
Senior Claims Examiner
Morris Associates is a third party administrator of medium size. I was in charge of several small accounts. I was responsible for processing and servicing of medical, dental, and disability claims.
Analyzed and adjudicated health, dental, disability and vision insurance claims
Continued high level of customer and provider contact and satisfaction
Maintained highest excellent level of production and quality standards
Examined and interpreted state and federal legislation affecting benefit plans.
Expertise in ICD•••••, Advanced CPT, and HCFA coding, medical terminology, pharmacology, and basic insurance

Benefit Systems
Indianapolis, IN
•••••
Senior Claims Examiner
Benefit Systems is a third party administrator of medium size. I was in charge of several accounts. I was responsible for processing and servicing of medical, dental, and disability claims.
Analyzed and adjudicated health, dental, disability, and vision insurance claims
Accountable for processing and servicing claims
Exceeded the highest level of production and quality standards
Examined and interpreted state and federal legislation affecting benefit plans
Expertise in ICD•••••, Advanced CPT, and HCFA coding, medical terminology, pharmacology, and basic insurance

Key Benefit Administrators
Indianapolis, IN
•••••
Senior Claims Examiner
Key Benefit Administrators is a third party administrator of large size. Along with several small group accounts, I was responsible for the processing and servicing of a large city account, City of Evansville. I dealt with a high level of customer and provider contact, as well as maintained a high level of production examining claims.
Processed high volume medical and dental claims
Provided excellent, full customer service (external and internal)
Set the record in the company for production standards
Earned regular bonuses for high production and quality
High daily level of external and internal customer and provider contact including face to face contact with insureds in question/answer sessions to insure high level of customer satisfaction
Expertise in ICD•••••, Advanced CPT, and HCFA coding, medical terminology, pharmacology, and basic insurance

Aetna Health Plans
Indianapolis, IN
•••••
Senior Claims Examiner
Aetna acted as a third party administrator for a national chain of department stores. I was responsible for the review and processing of group medical and dental benefits. This required analyzing and applying all contractual provisions according to current legislation. Although I was considered a Medicare Specialist, I was utilized in several areas of my division. I was chosen to act as a System Enhancement Specialist. One of the primary responsibilities of this duty was to develop training procedures for other examiners on our team as new computer programs were implemented. I had the opportunity to develop my managerial potential by acting as a supervisor on numerous occasions. Fielding and handling calls in the customer service area was a part of my claims experience as well. I was involved in numerous special projects working directly with the corporate officials whose plan we administered.
Supervisory lead performer at highest level of seniority and ranked nationally in production
Met highest standards of production and quality, 3rd ranked in Aetna nationally
Trained employees on software and program updates
Analyzed and adjudicated, serviced, and audited claims for numerous group accounts
Honed expertise in ICD•••••, Advanced CPT, and HCFA coding, medical terminology, pharmacology, and basic insurance

EDUCATION:
Anthem (Wellpoint): ••••• week in-service training
Aetna Insurance: 9 months in-service school

Clinton Prairie High School, Frankfort, IN
Academic honors diploma