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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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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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