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inter plan program service specialist resume example with 8+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Personable and dedicated Service Specialist with extensive experience in the healthcare insurance industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients.

Skills
  • Customer follow-up
  • Problem resolution
  • Data management
  • Technologically savvy
  • Project management abilities
  • Microsoft Office expertise
  • Inbound and Outbound Calling
  • BCBS Association guidelines
  • Data evaluation
Experience
Inter-Plan Program Service Specialist, 12/2017 - Current
Blue Cross Blue Shield Of North Carolina City, STATE,
  • A service relationship professional, handling incoming telephone or electronic partner plan inquiries from beginning to end to meet the Association performance metrics and improve overall member/provider satisfaction with the Blue Card Program and BCNC.
  • Privacy Coordinator for Plan to Plan Services.
  • Utilize problem solving methods and claims experience to adjust IPP member and provider claims as needed at the point of entry avoiding delays caused by hand-offs to other internal areas.
  • Subject matter expert on Inter-Plan business across all lines of business.
  • Identifies problems, gaps, or inconsistencies in workflows, and/or processes; recommend updates, alternatives and/or solutions.
  • A point of contact for internal and/or external audits and projects as necessary; assists in planning, identifying trends, system testing, training and implementation.
  • Handle special projects as necessary; create and report on project data analysis.
  • Present IPP specific information to internal partners, including large groups or teams.
  • Identify, fix, and eliminate operational issues that are identified as trends/patterns of untimely, inaccurate, non-compliant, or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple systems and inquiry platforms.
  • Develop and maintains assigned reports as required.
Customer Service Professional / Inter Plan Program Host, 06/2016 - 12/2017
Blue Cross Blue Shield Of North Carolina City, STATE,
  • Provider Services.
  • Educate Providers on BCNC practices and policies.
  • Utilize proper customer service protocols/procedures and job aids.
  • Educate and encourage external customers on use of alternative service channels including Blue E, and Blue Connect.
  • Support the business by providing World Class Customer Service.
  • Assist NC providers with claims submitted for out of state Blue Plans.
  • Including contacting the “Home Plan” for additional assistance, sending general inquiries, and researching denials.
  • Skilled in IPP Host, Commercial Claims, Commercial Benefits and Eligibility.
  • Identify and communicate process, product, or systems improvement opportunities to improve the overall stakeholder experience.
Universal Patient Services Coordinator, 01/2012 - 10/2015
Biogen Pharmaceuticals City, STATE,
  • Assisted and provided information to patients, health care providers, and vendors about Biogen products and services that make up the Multiple Sclerosis franchise.
  • Handled and coordinated services associated with incoming calls that are generated by the Case Management process for Avonex, Tysabri, Plegridy, and Tecfidera.
  • Responsible for receiving inbound calls from current Multiple Sclerosis patients and/or potential patients regarding Biogen products or services.
  • Provided friendly, professional, and accurate information to patients and healthcare professionals about Biogen therapies and available Patient Service programs including, but not limited to financial assistance, patient events, and peer programs.
  • Accessed and utilized knowledge management database to reference Talking Points, Standard Operating Procedures, and Departmental Practices to provide consistent, compliant, and accurate information to callers.
  • Served as a patient advocate and advisor by guiding patients and providers through the start process and therapy retention.
Education and Training
: Healthcare Administration, Expected in
-
Strayer University - Durham, NC
GPA:
Status -
Medical Coding II – Certification: , Expected in 12/2003
-
Durham Technical Community College - Durham, NC
GPA:
Status -
Medical Coding I – Certification: , Expected in 10/2003
-
Durham Technical Community College - Durham, NC
GPA:
Status -
Medical Terminology I – Certification: , Expected in 04/2003
-
Durham Community College - Durham, NC
GPA:
Status -

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Resume Overview

School Attended

  • Strayer University
  • Durham Technical Community College
  • Durham Technical Community College
  • Durham Community College

Job Titles Held:

  • Inter-Plan Program Service Specialist
  • Customer Service Professional / Inter Plan Program Host
  • Universal Patient Services Coordinator

Degrees

  • Some College (No Degree)
  • Medical Coding II – Certification
  • Medical Coding I – Certification
  • Medical Terminology I – Certification

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