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customer service manager benefits vendor relationship mgr provider relations claims manager resume example with 17+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Focused and dedicated professional motivated to provide superior customer service. Would like to demonstrate my abilities and knowledge that I have gained through my experience and be a valuable asset within your organization.

Experience
Customer Service Manager, Benefits & Vendor Relationship Mgr, Provider Relations Claims Manager, 05/2013 - 08/2015
Brink's Incorporated Cincinnati, OH,

Began as Customer Svc Manager and assisted in the implementation and building of new department to assist with membership. Trained new employees on ACA plans, guidelines and procedures in order to provide best possible customer experience. Worked in team environment to review and submit 109 new plans to the DOI for effective date of 1/1/14.

Jan 2014 I was promoted to Benefits and Vendor Rel. Mgr and assisted with ensuring our many vendors were providing optimal service. I worked with many vendors which included Insure Monkey, UniteHereHealth, Catamaran and Eldorado.

Jan 2015 I moved laterally into the position of Provider Relations Claims Manager. I continued in this position until NHC announced it would be closing its doors at the end of 2015 and my position was eliminated. I worked very closely with the medical management team and the various providers. I met with a number of providers whenever there were any issues or confusion regarding the contract reimbursements or delay in payments. I performed many functions within NHC. I did any function that was necessary to assist in the member experience. I not only met with the providers and vendors but there were many times I met with members to assist in understanding. By the time I left NHC there were approximately 160 plans. I also spoke at Broker Meetings in order to educate about the plans in order for our broker partners to be able to effectively inform the public about NHC and assist potential members about their various choices on the marketplace.

Medical Claims Processor, 11/2012 - 05/2013
Brink's Incorporated Tampa, FL,
  • Use my knowledge with medical claims to assist in setting system guidelines and protocols so that claims can be processed in accordance with the Fund's Summary Plan Description during conversion.
  • Process medical claims.
  • Assist customers and Fund Trustees with understanding claims payments.
  • Handle refund requests, overpayments and adjustments when necessary.
  • Process claims for Teamster Local 631, Las Vegas Fire Fighters and Miscellaneous Fund 108 (California).
Medical Claims Processor, 11/2002 - 11/2012
Brink's Incorporated Albuquerque, NM,
  • Began in customer service and after 30 days was promoted to medical claims processor.
  • Worked with multiple funds including Teamster Local 631, Southwest Admin.
  • Employee claims and primarily Las Vegas Fire Fighters.
  • Assisted with system conversions on all three funds.
  • Worked closely with City of Las Vegas Work Compensation and with the EAP provider, Mines and Associates, in order to e*ciently process benefits in the most e*ective manner.
  • Verified possible work compensation cases with the City of Las Vegas in order to maximize benefits and to ensure reimbursement from the work comp carrier.
  • Worked closely with the Las Vegas Fire Fighter Trustee James Suarez to explain member's claims and how they were processed for payment or to explain benefits.
  • Priced claims manually for Coalition providers.
  • Priced claims on the Beech Street website to determine PPO & NON-PPO Providers.
  • Priced claims thru the Blue Cross Website for our California employees and providers.
  • Accessed the Office Ally website for additional claim information on EDI claims.
  • Assisted with provider appeals or disputes of contractual pricing issues.
  • When transitioning from Southwest Admin to Northwest Admin my primary goal was to ensure that the information was given to the new administration for the least amount of interruption of the members benefits and services.
  • Worked as backup for the administrative assistant when she had to be away from the o*ce covering telephone calls for Account Executive and the Assistant Account Executive.
Medical Claims Processor, 04/1997 - 04/2002
Mandalay Resorts Inc City, STATE,
  • Processed medical claims for Mandalay Resorts employees.
  • Applied practical knowledge to the processing of medical and vision claims.
  • Manually priced hospital claims.
  • Electronically priced claims through the Beech Street system for multiple providers and services.
Education
Certificate: Medical Assistant, Expected in December 1992
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American Academy Of Medical Assisting - Las Vegas, NV
GPA:
Status -
Skills

Computer Literacy: Javelina, AS-400, V-3, RIMS, Mainframe, Word, Outlook, Some Excel

ICD-9, CPT, ASA, HCPC Knowledge

Medical Terminology

HIPAA Regulations

Prior Authorizations

Advanced Customer Service Skills

Strong research & resolution skills

Strong verbal and written communication skills

Familiar with COB and Cobra policies

Strong Typing and 10 key by touch

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Resume Overview

School Attended

  • American Academy Of Medical Assisting

Job Titles Held:

  • Customer Service Manager, Benefits & Vendor Relationship Mgr, Provider Relations Claims Manager
  • Medical Claims Processor
  • Medical Claims Processor
  • Medical Claims Processor

Degrees

  • Certificate

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