Employer Service Representative Resume Example

• 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.

• 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.

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