Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary
Well-trained Customer Advocate, offering vast experience in healthcare customer service, excellent interpersonal communication skills and comfortable in building working relationships with our clients and customers.
Skills
14 years of experience as a health care customer advocate.
Excellent problem solving and communication skills, both verbal and written.
Ability to sustain work pressure in an efficient way.
Exceptional interpersonal skills.
Well organized, detail oriented, possitive attitude and strong work ethics.
Honest, hard working, respectable and caring.
Excellent team player.
Fast learner and flexible with work timings.
Work History
04/2011 to Current
Customer AdvocateAlly – Troy, MI,
Provide exceptional and professional customer service to our customers, clients and peers in a prompt and efficient manner.
Resolve internal and/or external escalated issues for benefits, claims and customer inquiries within the require timeframe.
Perform extensive and precise research for any benefit,claim and/or pharmacy inquiries required by CSP and claim adjusters to perform their duties with fewer delays.
Focus on our client and customers needs and expectations to ensure the best possible information and/or resolution is provided.
Request Access to care updates for both active and retiree customers.
Assist and promote various Wellness programs.
Engage and/or conduct weekly meetings with CSP,manager and peers to bring forth any concerns, issues or possible trends with the City of Houston account.
Face to face interaction with client and customers on a daily basis.
Provide support to interal/external peers, CSP, Sales etc.
Establish and maintain good working relationship with client and customers
Excellent computer skills and knowledgeable with various software programs. (Oneview, Argus, CED, CPF, ICMS, MHS, MSS, Word, Excel, Outlook etc)
04/1999 to 04/2011
Customer Advocate SpecialistBlue Cross Blue Shield Of Texas – City, STATE,
Responsible for resolving basic/escalated internal and external benefits, claims and member inquiries.
Data entry, process and finalize claims.
Performed claim adjustments for Medicare, HMO and PPO products.
Investigate and submit requests through Financial Suspense System to recuperate financial overpayments.
Inform the policies and procedures to the members.
Update membership and prescription inquires.
Update Secondary insurance Information.
Assist with Retirees with Medicare Coordination of Benefit inquiries and updates.
Performed various tasks in a timely manner.
Handle written correspondence from members and providers.
Communicate with Healthcare professionals to resolve issues.
Promote Wellness Programs.
Participate in City of Houston Annual Open Enrollment meetings.
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