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Professional Summary
Detailed-oriented individual looking to obtain a position that will allow me to utilize my extensive customer service, financial skills and abilities to support the growing needs of a company. Experienced Claim processor successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 5+ years of experience and willingness to take on any challenge.
Skills
Professional and Friendly demeanor with strong problem solving skills
Excels at multi-tasking in fast-paced environment, completing projects within time and handling multiple priorities
Ability to follow and comprehend instructions, short correspondence, and memos
Proficiency in MS Excel, Word, Outlook, Power Point and data entry
Very dependable and willing to shift work duty based on business needs
Work History
10/2020 to CurrentCollections RepresentativeMarriott Vacations Worldwide | Marco Island, FL,
Reviewed collection reports to determine status of collections and amounts of outstanding balances.
Used skip tracing resources to locate debtors and updated information in company system.
Recorded all information regarding financial status of customers.
Used probing techniques to determine debtors' reasons for delinquency.
Negotiated to collect balance in full.
Resolved challenging situations with friendly but firm strategies.
Achieved performance goals on consistent basis.
Managed approximately 70 inbound and outbound calls daily
09/2017 to 09/2020Pharmacy CSR /Claims ProcessorNorthwell Health | Great Neck, NY,
Educates customers on benefits, use of plan, formulary, premiums and status of orders, claims or inquiries.
Answers incoming calls; assists customers/pharmacies/physicians with orders and reorders, benefit eligibility questions and prescription status inquiries. Escalates drug related calls to appropriate pharmacist.
Makes outbound calls on prescriptions with holds on orders and payment issues.
May also assist with entering new prescription orders into system.
Review and research claims by navigating multiple computer systems and platforms and accurately capturing data/information necessary for processing (e.g. Verify pricing, prior authorizations, applicable benefits, coding
Analyze, investigates, and process Medical Claims
Adjust Medical Claims
Claims processing
Price Medical Claims
Audit Appeals and Grievance for compliance errors • Medicare and Medicaid Knowledgeable
Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
Verified claim data correctness in preparation for processing
08/2014 to 09/2017Legal AssistantL'oreal | San Francisco, CA,
Kept cases organized by establishing and organizing files, documenting actions, Inputting information into file database and case management software.
Develop cases by maintaining contact with people involved, scheduling depositions, preparing summonses and subpoenas, drafting complaints, preparing/filing discovery requests, preparing responses to opposing counsel/generating status reports.
Keep clients informed by maintaining contact/communicating case progress maintaining case costs by verifying outstanding balances with attorney, clients and providers.
Enhanced trial proceedings by organizing evidence, preparing exhibits, scheduling witnesses, and ensuring that witnesses are ready when needed.
Supports case preparation by preparing case summaries and materials for mediation conferences, preparing pleas, monitoring/obtaining discovery responses and organizing materials for team case review.
Managed accounts and client records of clients, observing confidentiality and extreme discretion.
Worked alongside attorneys, administrative assistants and fellow legal assistants on complex cases and legal processes.
Scheduled appointments, court appearances and depositions for busy criminal and personal injury law firm with 2 attorneys.
08/2013 to 02/2014Customer Service RepresentativeFanatics | City, STATE,
Receive inbound payment calls including transferred sales leads and calls from current and potential customers.
Answer questions about product details, the company, and issues with account for customers.
Assist customers with any technical issues experienced with website and escalate any issues to management appropriately.
Perform basic account maintenance activities.
Provided primary customer support to internal and external customers in fast-paced environment.
Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Education
Expected in Associate of Arts | LPNJersey Nursing College, Jacksonville, FL, GPA:
Expected in 05/2006High School Diploma | Andrew Jackson High School, Jacksonville, FLGPA:
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