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Anthem Blue Cross - Customer Associate Iii Resume Example

Abigail Morgan
XXXX XX XXXXX XXXXX XX, La Puente,CA 91744
XXXXXXXXXXXXXXXXXX
Ph: XXXXXXXXXX
Professional Summary

Service-oriented customer service associate with 28 year background in the Healthcare Industry to include HMO, PPO.
Core competencies include 10 key by touch,  Microsoft Office, Medical Insurance Billing and Coding, Claims adjudication.

Skills
  • Active Listening
  • Customer and Personal Service
  • Excellent communication and time management skills. 
  • Handles tasks with accuracy and efficiency.
     
Experience
Customer Associate III: Apr 2006Present Anthem Blue Cross: Diamond Bar, Ca Responds and resolves inquiries from members via telephone.
Interacts professionally with members verbally and in written form .
Interprets plan benefit design, resolves claim issues, benefits, and enrollment issues.
Educates and communicates  the benefit design packages to members.
Engaged in successful research and resolution of high level/sensitive customer service issues.
Works independently, take ownership, and pay  attention to detail .
Monitors and provides follow-ups to ensure timely resolution and closure to member issues.
Refund Analyst: May 2004Apr 2006 UCLA Patient Business Services: Los Angeles, Ca Reviewed credit balances and refund requests in a timely manner.
Followed refunds and reimbursement protocols for different payors.
After reviewing credit balances, refunded the appropriate party according to contractual obligations or policy terms.
Reversed the over adjustments that created the credit balance or transfer the existing credit balance to the appropriate account.
Knowledge and understanding of billing and collections guidelines and procedures as well as corresponding with third party payors over the phone or otherwise.
Prior Authorization Coordinator: May 2003May 2004 Pacificare Health Systems: Cypress, Ca Inputs and processed authorization requests and auto authorization per company guidelines and according to defined time and accuracy standards.
Collector: Feb 2000May 2003 CMRE : Brea, Ca Made credit decisions concerning new accounts and established limits.
Developed payment schedules with accounts.
Claims Examiner III: Nov 1994Feb 2000 UCLA Medical Group: Los Angeles, Ca Accurately processed professional and institutional claims
Analyzed and adjudicated claims to ensure accurate payment
Interpret Capitated Provider Contracts
Meet department quality and accuracy standards.
Interfaces with other departments to ontain necessary information required for resolution of claims.
Advise management of any claim issues or inappropriate and/or incorrect billing.
Did some negotiations on certain billing with management approval.
Education
Bachelor of Science: Business Management, Jun 1977 Philippine Women's University, Manila, PI
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Resume Details

This is a real resume for a Customer Associate III in La Puente, California with experience working for such companies as Anthem Blue Cross, Ucla Patient Business Services, Pacificare Health Systems. This is one of the hundreds of Customer Associate III resumes available on our site for free. Use these resumes as templates to get help creating the best Customer Associate III resume.

Previous Companies:

  • Anthem Blue Cross
  • UCLA Patient Business Services
  • Pacificare Health Systems

Previous Job Positions:

  • Customer Associate III
  • Refund Analyst
  • Prior Authorization Coordinator
  • Collector
  • Claims Examiner III

Schools:

  • Philippine Women's University

Level of Education:

  • Bachelor of Science

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