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Contact Representative Resume

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TECHNICAL SKILLS:

  • Keyboarding
  • Microsoft Office
  • Unemployment claims
  • Workers compensation claims
  • Fax, filing, answering phones
  • Call Center/Customer Service chat/ emails
  • Escalated calls
  • Heath claims reimbursement
  • Health Recovery specialist
  • Claims and commercial insurance
  • Processing claims
  • Hire Desk Applicant Zendesk
  • Service Tracking System
  • Tech support and Trouble shooting level one

PROFESSIONAL EXPERIENCE:

Confidential

Contact Representative

Take first interview report for short term and long term disability and FMLA requests. Assist and process leave of absences, FMLA and short - term disability claims. Fax appropriate documentation and inform of qualifications for available services. Field questions on benefits payment and billing on policies In a call center environment as well as remote. Provide great problem-solving customer service skills. Answer email and chat. Provide outstanding customer service. Provide tier one support with software and onboarding via phone chat and email

Confidential, North Carolina

Customer Service Representative

Review and investigate claims for overpayment. Pay claims according to company guidelines. Assists with enrollment issues. Request reimbursement from providers where claims paid in coding errors or duplicate ICD-10 codes. Validation and payment posting of medical reimbursements. Corresponding with providers to resolve claims issues. Vouchering of claims institutional, COB (Coordination of Benefits) and Professional Claims management. Reinstate policies, invoicing, review covered benefits, premiums etc. Take incoming calls regarding benefits, coverage and Pharmacy claims. Assist customers with prescriptions and prior authorizations. Knowledge of MY Prime. Prime Therapeutics and RX Claims, FASCETS. Order replacement cards assist with all customer service issues via Call center environment and chat, Provide tier one support with software and onboarding.

Confidential, IN

Contact Center Representative

  • Take first reports for auto, liability, Short term disability and property claims via phone.
  • Conduct interviews and investigate claims to assist adjuster in making timely decisions
  • Promptly assist claimants to provide a quick resolution
  • Provide tier one support with software and onboarding
  • Answer all inquiries on services vial email chat and phone
  • Payments and payment arrangements reinstatement

Confidential

Contact Center Representative
  • new accounts, offered beneficial new products and services.
  • Explained charges and fees to credit card account. Credit limit increase. Take payments set up limit increase request Order tracking of new products and services

Confidential, Atlanta, GA

Unemployment claims Adjuster

  • Conducted interviews and created fact findings to make monetary decisions on claims for unemployment.
  • Investigate and handled claims process from start to finish
  • Provided job readiness assessment and job referrals for reemployment where applicable.
  • Provided Maintenance on continuing claims.
  • Made binding decisions based on applicable state laws.
  • Conducted group sessions for job search activities, resume building etc.

Confidential, Raleigh, NC

Adjuster/Reemployment

  • Interviewed Individuals to determine eligibility for unemployment benefits, assist with referrals to other agencies.
  • Maintenance on existing long-term claims.
  • Made binding decisions based on state employment laws in a timely manner adhering to deadlines and state employment laws and regulations.

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