LiveCareer-Resume

provider resolution coordinator resume example with 7 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

Hardworking and reliable individual with strong ability in time management and leadership skills. Offering communication, problem solving and customer services skills. Highly organized, proactive and punctual with team-oriented mentality.

Skills
  • Communication
  • Troubleshooting
  • Flexible
  • Teambuilding
  • MS Office
  • Friendly, positive attitude
  • Microsoft Office
  • Leadership
  • Reliable and trustworthy
  • Conflict resolution
  • Decision-making
Experience
Provider Resolution Coordinator, 06/2019 - Current
Johns Manville Corp Waterville, OH,
  • Process claims and adjustments identified in service requests from Customer Service.
  • Review and research incoming healthcare claims from providers and verify the data/information necessary for processing.
  • Identify, analyze and resolve common, complex, and escalated operational issues impacting professional and hospitals systems.
  • Identify and document global and/or systemic problems, gaps, or inconsistencies in workflows, and/or processes based on collected information.
  • Provide analysis and feedback for technologies, trends, best practices, and service offerings.
  • Provide coaching and feedback to customer service and claims departments regarding claims and claims errors.
  • Educate and encourage providers on use of alternative delivery channels including self-service, Blue E, web, etc.
  • Provide cross functional support between the provider and various areas within the Plan including local, state and federal government entities across all lines of business
  • Effectively manage inventory to meet departmental goals and Service Level Agreements (SLA)
  • Handle special projects or requests from Provider Service Consultants and Coordinators as necessary.
  • Manage team mailbox and escalation phone line to address issues received from the Provider Service Consultants and Coordinators, Network Management, and the Leadership Team.
Customer Service and Claims Professional, 03/2017 - 06/2019
Blue Cross And Blue Shield Of NC City, STATE,
  • Utilize probing and creative problem solving as well as critical thinking and the ability to analyze complex and ambiguous information to resolve customer inquiries on first contact.
  • Identify and obtain information and records from customers, members, providers and/or employer groups to correct/update information, claims records when necessary.
  • Recognize patterns of inconsistent and/or inaccurate claims filing practices among providers, providers on acceptable BCBSNC practices and policies.
  • Review and research incoming healthcare claims from providers(doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
  • Process claims and adjustments identified in service requests from Customer Service
  • Communicate and collaborate with providers to resolve issues,
  • Review and research incoming healthcare claims from providers by navigating multiple computer systems and platforms and verifies the data/information necessary for processing
  • Meet or exceed established quality and performance standards
  • Provide coaching and feedback to customer service department regarding claims and claims errors.
  • Conduct huddle sessions to discuss how to effectively and efficiently research a claim.
Customer Service Advocate, 08/2014 - 03/2017
Blue Cross And Blue Shield Of NC City, STATE,

• Utilize knowledge of product types, functional and/or technical skills to provide solutions for insurance questions and issues.
• Communicate with providers and colleagues in verbal and written form.
• Display leadership internally and externally.
• Utilized probing and creative problem solving as well as critical thinking and the ability to analyze more complex information to resolve customer inquiries on first contact.
• Ensured final outcomes of each inquiry in a timely manner while providing and documenting accurate information to the customer.
• Identify and obtain information and records from providers to correct/update information, claims and membership records when necessary.
• Recognize patterns of inconsistent and/or inaccurate claims filing practices among providers, educate providers on acceptable BCBSNC practices and policies.
• Perform phone/email outreach to BCBSNC vendors and business partners to resolve service issues.
• Identify, understand and anticipate customers’ unexpressed needs and concerns in a caring manner.
• Work collaboratively with Sales, Healthcare and Network Management partners to further provider relations.
• Educate and encourage customers on use of alternative delivery channels.
• Identify and communicate process, product or systems improvement opportunities to improve the overall provider experience.
• Interface with local, state and federal governmental entities and plan participants regarding BCBSNC products, services and policies.

Education and Training
High School Diploma: , Expected in 06/1996
-
East Rowan High School - Salisbury,
GPA:
Status -

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • East Rowan High School

Job Titles Held:

  • Provider Resolution Coordinator
  • Customer Service and Claims Professional
  • Customer Service Advocate

Degrees

  • High School Diploma

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: