Appleone - Member Outreach Specialist Resume Example

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Alexander Wilson

XX XX XXX XXXXX , Oxnard , CA 93031 | (H) XXXXXXXXXXXX | XXXXXXXXXXXXXXXXXXXX

Professional Summary

Accomplished and energetic Health Plan Representative with a solid history of achievement in Administrative Healthcare Field. Motivated leader with strong organizational and prioritization abilities. Areas of expertise include Medical Insurance, Customer Service, and Problem Solving.

Skills

Leadership & Team Player
20 years Customer Service

15 years Insurance Field
Complex Problem Solving

Medical Office
Billing

Medical Terminology
Pharmacy authorizations

Experience

Member Outreach Specialist 05/2012 to 07/2013
Appleone – Thousand Oaks, Ca

Outbound calls to members regarding health issues and educating on health plan benefits.
Process, generate and send letters of approvals, and submit to healthcare providers.
Input medical information into WMDS system in accordance with all regulatory timeframe.
Follow-up on member calls regarding health related issues and qualifying programs for the low income.

Health Benefits Specialist III 04/2008 to 01/2011
Wellpoint – Newbury Park, Ca

Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.

Review insurance policy terms to determine whether a particular loss is covered by insurance.

Check to ensure that appropriate changes were made to resolve customers' problems.

Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.

Confer with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints.

Senior Customer Service Representative 11/1998 to 11/2005
Blue Cross – Newbury Park, Ca

Processed Appeals & Grievances
Audit unit calls for quality assurance
Reviewed & Authorized pharmacy exceptions for medications
Assisted with training groups of 30+ new hire employees
Assisted with supervisor calls as needed related to health plan denied medical care.

Education

Associate of Science: Health Information Technology Mar 2012 Charter College - Oxnard, Ca

GED: Mar 1988 Oxnard Adult Ed - Oxnard, Ca

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Senior Customer Service Representative Member Outreach Specialist

Resume Details

This is a real resume for a Member Outreach Specialist in Oxnard, California with experience working for such companies as Appleone, Wellpoint, Blue Cross. This is one of the hundreds of Member Outreach Specialist resumes available on our site for free. Use these resumes as templates to get help creating the best Member Outreach Specialist resume.

                                        Previous Companies:
                                        Appleone
Wellpoint
Blue Cross

                                

                                        Previous Job Positions:
                                        Member Outreach Specialist
Health Benefits Specialist III
Senior Customer Service Representative

                                

                                        Schools:
                                        Charter College
Oxnard Adult Ed

                                

                                        Level of Education:
                                        Associate of Science
GED

                                

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