Senior Customer Care Representative Resume

Summary
Experienced claims processor able to handle complex claims. Excellent research and follow-through ability. Work without significant guidance with understanding of multiple products (PPO, COB, etc.) Understand application of benefits contracts, government regulations. Self motivated and a good team player. Received several awards for quality and perfect attendance.

Professional Experience:

Confidential, Plano, TX 7/1984-4/2010
Senior Customer Care Representative

Adjusted customer complaint resolutions of medical claims
Organized and reviewed claims and compared them against policy provisions
Entered and paid claims
Interpreted benefit policies to pay claims

Confidential
Claims Processor

Audited post paper medical claims. Reported quality, processing and financial errors
Handled customer and provider phone calls
Adjusted claims
Processed medical claims including basic, indemnity, PPO and Medicare

Education:

Training:

Medicare
HIPPA
Annual classes in Ethics & Corporate compliance
1.3 Erisa training program
Health care fraud and abuse awareness

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