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Member Services Representative Resume

SUMMARY

  • Skilled at learning new concepts quickly while working well under pressure
  • Ability to maintain organized records
  • Ability to work quickly, accurately and independently in a fast paced environment
  • Windows 2007 and higher; Windows NT
  • Microsoft Office Suites

PROFESSIONAL EXPERIENCE

Confidential

Member Services Representative

Responsibilities:

  • Customer Service to members
  • Computer updates (employee insurance)
  • Process client files
  • Generate correspondence
  • Enter enrollment forms, declination forms, address changes

Confidential

Administrative Assistant

Responsibilities:

  • Billing and follow - up of claims to Medicare
  • Entered claims information into the processing systems
  • Researched and followed-up of unpaid claims by using medical records

Confidential

Medicare Provider Support Representative

Responsibilities:

  • Processed and completed the following in accordance with Centers for Medicare Services guidelines: Internal overpayments (interoffice, Skilled Nursing Facility/Home Health Association, deceased beneficiary, system errors, and as a result of audits).
  • Assisted coding and routing to third party providers
  • Work aged account receivables, analyzes, determine appropriate action
  • Verified benefits and claims payments information.
  • Executed the full claim adjustment, started collection activities and ensure interest is assessed accurately.
  • Answered multi-line telephone, routed calls, and took accurate messages
  • Researched claims and corrected billing issues that dealt with the benefit and premium inconsistencies.

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