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Client Account Specialist Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Summary

Hardworking and reliable client account specialist with strong ability in client focus, teamwork, and goal oriented. Highly organized, proactive and punctual with team-oriented mentality.

Skills
  • Product and service knowledge
  • Teamplayer
  • MS Office
  • Team building
  • Six Sigma Green Belt Certfied
  • CBA Star of the Month(very first one awarded)
Experience
Client Account Specialist, 02/2013 to Current
GenslerLa Crosse, WI,

The Client Account Specialist role is directly responsible for the day to day operational relationship & management of client inventory within assigned CBA Payers. I have been the specialist assigned to the Anthem/Amerigroup and Humana clients. I am tasked with identifying client-specific needs and maintaining expert-level knowledge of accounts. And cultivating strong and trusting relationships with with client contacts to promote retention and satisfaction.

• Payer Submission Files: Creates and delivers CBA Payer specific submission files.
• Payer Response Files: Receives and processes CBA Payer specific response files.
• HMS Client Portal: Responsible for communication with assigned CBA Payers via HMS Portal.
• Exceptions Processing: Processes internal suspense and research for assigned Payers.
• Double Dips: Submits and performs follow up on double dip/incorrect refunds for assigned payers.
• Client Questions/Requests: Fields claim level questions/requests from Payer contacts.
• Field Questions: Fields payer specific claim level questions/requests from HMS Field Staff.
• Payer Fee Denials: Works with field staff for additional information as needed to appeal claims for which the Payer has denied HMS fee payment.
• Voids: Process void requests from both HMS field staff and the Payer.
• Quarterly Trending/Analysis of Exception claims: Evaluate, interpret, and analyze Payer exceptions & voids for trending.
• Payer Guidelines: Document & maintain updated policies and procedures for Payer refund processing.
• Client Operations Liaison: Resource for QA and Pre-ID Department with client specific questions/ requests.
• Client System Access: Maintains list of CBA users that have access to Payer system(s). Notify Payers as needed of updates. (ex. term employee)
• Contract Requests: Requests contracts from Payer as needed for field staff.
• Other duties as assigned

Client Account Specialist, 10/2011 to 11/2012
GenslerMiami, FL,

The Client Account Specialist role is directly responsible for the day to day operational relationship & management of client inventory within assigned CBA Payers. I was assigned as the specialist for the Anthem clients. I was tasked with identifying client-specific needs and maintaining expert-level knowledge of accounts. And cultivating strong and trusting relationships with with client contacts to promote retention and satisfaction.

• Payer Submission Files: Creates and delivers CBA Payer specific submission files.
• Payer Response Files: Receives and processes CBA Payer specific response files.
• Responsible for communication with assigned CBA Payers via Portal.
• Exceptions Processing: Processes internal suspense and research for assigned Payers.
• Double Dips: Submits and performs follow up on double dip/incorrect refunds for assigned payers.
• Client Questions/Requests: Fields claim level questions/requests from Payer contacts.
• Field Questions: Fields payer specific claim level questions/requests from Arbor Field Staff.
• Payer Fee Denials: Works with field staff for additional information as needed to appeal claims for which the Payer has denied Arbor fee payment.
• Voids: Process void requests from both Arbor field staff and the Payer.
• Quarterly Trending/Analysis of Exception claims: Evaluate, interpret, and analyze Payer exceptions & voids for trending.
• Payer Guidelines: Document & maintain updated policies and procedures for Payer refund processing.
• Client Operations Liaison: Resource for QA and Pre-ID Department with client specific questions/ requests.

Client Account Specialist, 06/2011 to 10/2011
GenslerPhoenix, AZ,

The Client Account Specialist role is directly responsible for the day to day operational relationship & management of client inventory within assigned CBA Payers. I was assigned as the specialist for the several Blue Shield and various TPA clients. I was tasked with identifying client-specific needs and maintaining expert-level knowledge of accounts. And cultivating strong and trusting relationships with client contacts to promote retention and satisfaction.

• Payer Submission Files: Creates and delivers CBA Payer specific submission files. • Payer Response Files: Receives and processes CBA Payer specific response files.

• Responsible for communication with assigned CBA Payers via Portal.

• Exceptions Processing: Processes internal suspense and research for assigned Payers.

• Double Dips: Submits and performs follow up on double dip/incorrect refunds for assigned payers.

• Client Questions/Requests: Fields claim level questions/requests from Payer contacts.

• Field Questions: Fields payer specific claim level questions/requests from AIM Field Staff.

• Payer Fee Denials: Works with field staff for additional information as needed to appeal claims for which the Payer has denied AIM fee payment.

• Voids: Process void requests from both AIM field staff and the Payer.

• Quarterly Trending/Analysis of Exception claims: Evaluate, interpret, and analyze Payer exceptions & voids for trending.

• Payer Guidelines: Document & maintain updated policies and procedures for Payer refund processing.

• Client Operations Liaison: Resource for QA and Pre-ID Department with client specific questions/ requests.

Senior System Access Analyst, 06/2008 to 06/2011
AIM HealthcareCity, STATE,

As a senior System Access Analyst, you would assist Regional Account Managers and or field management with client specific information needed to complete an audit. The Regional Account Managers call, multiple e-mails, and or fax information in to receive approvals or authorization.

•Review pre-approval claims for client specific requirements.
•Review claims that were date restricted.
• Maintain production standards.
• Complete production reports on monthly basis for the team for management
•Act as team management during PTO, absence, transitioning roles

Education and Training
High School Diploma: , Expected in 05/1997
Cornersville High School - Cornersville, TN,
GPA:

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82Good

Resume Strength

  • Length
  • Personalization
  • Strong Summary
  • Target Job

Resume Overview

School Attended
  • Cornersville High School
Job Titles Held:
  • Client Account Specialist
  • Client Account Specialist
  • Client Account Specialist
  • Senior System Access Analyst
Degrees
  • High School Diploma

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