Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
Professional Summary
Over 20 years of Office skills including: Customer Service Representative, Secretary, Receptionist, Call Center, Claims Analyst, State Hearing Analyst, and Clerical experiences. Excellent organizational, interpersonal, written, and verbal communication skills. Ability to work effectively both independently or on a team. Experienced in data entry, billings, payroll, and telephone skills. Knowledge in the use of other general office equipment. Strong computer skills. Ability to perform comfortably in a fast-paced, deadline-oriented work environment. Bi-lingual - Lao (speak, read and write); Thai (conversational). Committed to providing quality customer services and highly adaptable to ever changing circumstances. Major strengths include honest, hard working, energetic and motivated, competent, dutiful respect for compliance in a regulated environment.
Core Qualifications
Familiar with several word processing and computer systems, including Microsoft Excel, Microsoft Word, WordPerfect, Cammis, and CRM.
Office Skills: Ten-key Calculator (by touch), numerical filing, and alphabetical filing, scheduling, billing, answering phone, data entry, customer service, fax, copy and keyboarding. Knowledge of bookkeeping practices.
Experience
Claim Analyst and State Hearing (back up) analyst, 07/2011 to Xerox State Healthcare, LLC – City, STATE,
Respond to telephone inquiries and voice mail messages in a fast and efficient manner to Medi-cal Providers and Beneficiaries/Members in a high volume Call Center Utilize multiple databases to research and resolve telephone inquiries according to customer's needs Provide and explain regulations, policies, benefits to providers and beneficiaries.
Draft Position Statements for State Hearing cases.
Verbally explain the Department's position, as needed, to Administrative Law Judges on very sensitive legal issues.
Review and process out of pocket reimbursement claims for Medi-Cal Beneficiaries/Members.
Request information from attorneys, beneficiaries, and physicians as required by each case.
Ensure all necessary documents are properly scanned and attached in the correct fileng.
Utilize Medi-Cal manuals, policies, and procedures to assist providers and members with inquiries.
Research and resolve inquiries such as underpayments, overpayment, denials on claims, and eligibility.
Inform providers and beneficiaries/members about Medi-Cal rules and regulations and any new updated services available.
Provide clerical assistance to beneficiaries and Xerox and Department of Health Care Services staff.
Record Processing Rep, 01/2005 to 03/2009 Washington Mutual Bank – City, STATE,
Researched and retrieved Bank documents at the request of various back office support departments (e.g., Consumer Banking, Subpoenas, Legal, Loan Processing, Human Resources, Benefits, Payroll).
Interacted with internal customers on problem resolution and complex queries to ensure that the service level agreements were met.
Operated and serviced for standard office equipment, including PC/printer, calculator, photocopier, Fax machine and data scanner.
Utilized applications as required by specific job duties (records management database software spreadsheet, and word processing).
Retrieved record documents to provide on time and accurate records for legal requirement.
Performed accurate mathematic calculations to account for mandatory records.
Workers' Compensation Claims Clerk III, 11/1999 to 04/2004 Octagon Risk Services – City, STATE,
Accurately processing incoming and outgoing mail, data entry, filing, schedule medical evaluations and send appointment notices.
In charge of answering multiple phone lines, including taking messages and transferring calls to appropriate departments.
Greeted and directed visitors/customers to the right departments.
Provided clerical assistance to customers and other members of the staff Monitored inventory levels of office supplies and ordered replacements as necessary.
Verified and monitored prescriptions and treatments authorizations to MD and nurses for accuracy.
Completed nurse case and DMG referrals as requested by the doctors and nurses.
Monitored fax machine for incoming claims and input all new claims into computer in a timely manner.
Provided administrative support to claim adjuster/administrator by performing tasks such as created file make up of all claims, greeted, and directed visitors/customers to the right departments.
Processed payments and refunds for medical bills and claimants.
Compiled information, prepared and maintained a wide variety of data, reports and records according to established procedures; established and maintained filing systems; prepared a variety of documents including forms, flyers, schedules, newsletters and medical reports for attorneys and the WCAB with accuracy and in an efficient manner.
Completed copy work of medical reports for required file activity for vendors such as hospitals, attorney's offices and the WCAB.
Education
: , Expected in San Joaquin Delta College - Stockton, CA. GPA:
AA: , Expected in San Joaquin Delta College - Stockton, CA. GPA:
Professional Affiliations
Skills
Ten-key, Administrative, administrative support, attorney, Banking, Basic, Benefits, billing, bookkeeping, Calculator, Call Center, clerical, CA, CRM, customer service, data entry, databases, database software, Department of Health, fast, fax, Fax machine, fax machine, filing, forms, Human Resources, Insurance, inventory levels, keyboarding, Law, Legal, Loan Processing, Microsoft Excel, mail, office, Microsoft Word, newsletters, office equipment, Office Skills, Payroll, Pharmacy Technician, photocopier, policies, printer, problem resolution, requirement, Research, scanner, scheduling, service level
agreements, spreadsheet, taking messages, telephone, phone, voice mail, word processing, WordPerfect
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