Claims Resolution Specialist Resume Hampton, Virginia - Hire IT People

PROFESSIONAL SUMMARY:

Highly enthusiastic customer service professional with more than seven years of client interface experience and senior software engineering experience. I possess strong analytical skills and a broad range of computer expertise and administrative qualities.

SKILL:

Organization
Receptionist
Microsoft Oice
Typing 35+ WPM
Data Entry
10: key
Time Management Skills
Communication Skills

EXPERIENCE:

Claims Resolution Specialist

Confidential, Hampton, Virginia

Responsibilities:

Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations.
Identify when to pend to other departments based on guidelines.
Process all claim types by determining corrective action to be taken on various types of errors pended by the system and resolving interactive edits.
Translate, research, and verify claim information to determine if all requirements have been met.
Review submitted claim information and select correct procedure code and diagnosis code using ICD - 9ICD-10, CPT4, and HCPCS manuals.
Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.
Adjudicate specialty claims including, but not limited to, pharmacy, ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims or duplicate claims.
Reach out to Doctor's oices to help expedite claims

Customer Service Representative/Tech Support

Confidential, Chesapeake, Virginia

Responsibilities:

Demonstrate extensive field knowledge through eicient problem resolution
Troubleshoot cable boxes,internet modems,customer computers,password resets, telephone modems alongside customer
Refer diicult issues to upper management
Research solutions through computer database
Provide accurate information to customers
Contribute to high-level of customer satisfaction by constantly maintaining friendly attitude
Troubleshoot and fix oice equipment, including copy machine and phone system

Event Manager/Reservations Leader

Confidential, Chesapeake, Virginia

Responsibilities:

Edit Audio Files
Book conference calls for high level companies
Provide tech support for WebEx calls
Lead conference calls
Event moderator
Sending products and hard copies of the conference
Sharepoint
Adobe Audition
Power point

Commerical Test Desk

Confidential, Norfolk, Virginia

Responsibilities:

Monitors Network Elements, perform remote diagnostics, and escalate problems as required to quickly resolve problems.
Diagnostics includes toggling of multiple applications and sessions to troubleshoot & research issues.
Directs appropriate personnel to the location of the fault by analyzing diagnostic data for the telephone switch, headend data terminal equipment, commercial transport network, or Cox Internet routers, voice manager application.
Coordinates eorts of local field technicians to resolve customer problems by communicating information through the local CommCenter operation, MTC, System Operations Center (RNOC), Local Number Portability (LNP), Database Administration (DBA), Telephony Support, Confidential Services, ITPS or Customer Care Center.
Communicates with internal & external customers to confirm problem resolution and closes out trouble tickets in the reporting systems.
Enhances team productivity by documenting trends, escalating appropriately, and writing Methods and Procedures documents.
Assists the team with knowledge transfer by cross other team members.
In hybrid markets, perform feature corrections in the switch.
For hybrid markets, correct errors from auto provisioning and may perform manual provisioning for commercial customers.
May assist technicians in the field by phone to solve problems with plant, set-top boxes, cable modems, emta, niu, mvp, iad or customers' premise equipment.

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Claims Resolution Specialist Resume

Hampton, VirginiA

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