Employer Service Representative Resume Example
Personable, detailed-oriented customer service professional with more than 17 years experience in sales and claims insurance processing. Multi-tasker capable of performing complex functions while maintaining proficiency in learning new tasks. Strong verbal and written communicator with a keen sense of customer and company loyalty in providing quality customer service. Dependable, knowledgeable and reliable team player with excellent growth potential.
- Meticulous attention to detail Client relations specialist Team management Persuasive Conflict resolution techniques Focused on customer satisfaction Deadline-oriented Skilled multi-tasker.
- Successfully built rapport with the Account Management team to ensure the retention of High profile clients.
- Computer Proficiency
Used Microsoft Excel to develop inventory tracking spreadsheets. - Project Management
Worked directly with Sales, Implementation, IT and Offshore to ensure deadlines were met and benefits were interpreted accurately. - Reporting
Documented and managed inventory and reported it daily to management.
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Anthem, Inc. – Visalia , CA
- Resolved customer complaints by handling claim inquires, membership updates and billing inquiries.
- Provides operational support and expertise, as well as single point of service support (e.g., calls and claims) to key client contacts (HR, Benefit Administrators, client key decision makers, etc.) and Account Management.
- Services for complex client accounts with timely and effective response to client service related concerns and issues.
- Keeps operational teams appraised of client changes, culture, benefit intent, etc.
- Keeps account appraised of service related trends and issues, handles escalations and provides overall support to key client service related issues and needs.
- Primary duties may include, but are not limited to: Talks with complex clients by phone or in person to ensure the best service possible.
- Answers client inquiries regarding health plan or service issues.
- Responds to customer issues and investigates and resolves errors.
- Coordinates complaint resolution concerning billing or services rendered with appropriate department(s).
- Coordinates client service needs with other departments as required to ensure client service and satisfaction.
- Regularly attends and participates in on-site client visits as the need arises based on performance guarantees of that group.
Fat Cats – Mesa , AZ
- Responsible for assisting internal and external customers with full service aspects of customer service to include claims, and billing issues.
- Performs as a research advocate for customers and team members in handling sensitive issues involving Healthcare claims, inquires and other functions.
- Proficient in claims processing from initial stages through follow-up to ensure no rework or network issues follow.
- Provides guidance to customers regarding policies and procedures of insurance products and other workflow processes.
- Responsible for initiating interactions among other departments to ensure proper handling of claims and other benefits Analyzes claims to determine payment liability and to determine additional requirements as needed.
- Proficient with computing applications, keyboarding and database management to include, Qcare, ITS, CallCare Browser, Anthem Prescription RX and WGS 2.0.
- Provide customer service to clients and customers via E-mail, written correspondence as well as telephonic inquiries.
- Proficient in processing facility and professional claims.
- Experienced in Networx Pricing and Blue2.
Caresource – Cleveland , OH
- Performed as customer service representative for commercial and personal lines of business Screened and accepted insurance applications for prospective applicants Responsible for accurate data input of applicants' information into mainframe computer system for proper processing Responsible for handling daily customer and vendor inquires via telephone, walk-in and electronic Responsible for administrative functions to include cash handling, sorting of incoming/outgoing mail, correspondence, filing and system backup Maintained up-to-date knowledge of store policies regarding payments, returns and exchanges.
- Organized weekly sales reports for the sales department to track product success.
- Trained new employees quarterly.
Anthem Blue Cross Blue Shield – City , STATE
Analyzed and reviewed LG group and new and renewal business.
Assisted with determining and outlining customized benefits for LG groups.
Worked closely with Implementation, Sales Team and Quality to ensure accurate interpretations of benefits.
Responsible for coding and ensuring benefits were correctly loaded in the system.
Worked quickly and effectively to ensure deadlines were met for issuance of medical Identification Cards issuance.
Assisted with improving the auto-adjudication of medical benefits for the CONV LOB.
Reviewed and updated any errors and provided timely resolution.
Continuously worked on improving workflow and the streamlining of work processes.
Wrote Job Aids and was responsible for leading Quality and Technical calls in which information was distribute
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Resume Overview
School Attended
- Hardaway High School
- Troy University
Job Titles Held:
- Employer Service Representative
- Customer Service Representative/Claim Associate
- Customer Service Representative
- Benefits Analyst II
Degrees
- High School Diploma : Business Administration 1994
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