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Customer Service/Claims Processor/Examiner I Resume Example

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CUSTOMER SERVICE/CLAIMS PROCESSOR/EXAMINER I
Career Overview
Claims examiner with extensive knowledge of the medical and property subrogation industries. Energetic, outgoing and driven to reach company goals.
Core Strengths
  • Strong organizational skills
  • Seasoned in conflict resolution
  • Adaptive team player
  • Energetic work attitude
  • Customer service expert
  • Telecommunication skills
Accomplishments
Customer Service
  • Promoted from Customer Service, to Claims Processor and Claims Examiner I while at Equian.
  • Member of the CEO club while at Equian.
  • Promoted to the email team while at Accent Marketing.
Work Experience
08/2009 to 03/2017
Customer Service/Claims Processor/Examiner I HRI/Trover/Equian － Louisville, KY
  • Customer service specialist responsibilities included answering incoming calls from members of various health insurances to confirm if treatment was a subrogatable file. Achieved top incoming calls and quality assurance of 100%. Handled member complaints with minimal supervisor intervention.
  • Promotion to claims processor entailed detailed review of subrogatable files specifically for Kaiser Northern California Health Plan. Built rapport with insurance companies, attorneys and the health plan members to get information required to request for billing. Scheduled work load to handle all file reviews in the form of incoming/outgoing calls, emails, mail and faxes. Extensive knowledge of HIPAA, medical authorizations and subpoenas. Granted remote status and worked from home full time. 
  • Promotion to Claims Examiner I entailed review of billing for accuracy and sending out final liens to requester in order to recover money for the health plan. Actively negotiated with attorneys, insurance providers and members in order to resolve the health care lien. Salaried employee and work from home, so self motivated and set schedule to ensure all tasks were completed in a timely manner. Extensive use of math to determine recovery percentages.
01/2006 to 05/2009
Customer Service Representative Accent Marketing － New Albany, IN Provided customer support for members of BJ's Wholesale club. Responsible for answering all incoming calls and emails from members regarding club questions or complaints. Quality assurance and efficiency was exceeding of company goal. Promoted to email team due to my ability to communicate effectively. Organizational skills utilized in order to task myself to follow up with members regarding pending issues. 
Educational Background
Bachelor of Arts: Music Education University Of Louisville － Louisville , KY
Psychology Indiana University Southeast － New Albany, IN
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Resume Overview

Companies Worked For:

  • HRI/Trover/Equian
  • Accent Marketing

School Attended

  • University Of Louisville
  • Indiana University Southeast

Job Titles Held:

  • Customer Service/Claims Processor/Examiner I
  • Customer Service Representative

Degrees

  • Bachelor of Arts : Music Education
    Psychology

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