I am a highly motivated, reliable, and professional customer service and claims operations specialist with more than 35 years of work experience. I have supported customers, clients, patients, plan participants, and business partners across insurance, healthcare, telecommunications, logistics, sales, and public-service environments.
I have extensive experience handling high-volume inbound and outbound calls, responding to emails and voicemail, interviewing clients, documenting interactions, and performing accurate data entry. I am comfortable resolving concerns, identifying customer needs, explaining policies and benefits, and coordinating services and assistance.
My background includes Medicare claims processing, claims adjudication, insurance investigations, benefit review, settlement negotiation, and compliance with HIPAA, PHI, CMS, CPT, ICD-9, and ICD-10 requirements. I am experienced in reviewing documentation, maintaining claim notes, reporting trends, and applying contract guidelines.
I bring strong computer and office administration skills, including Microsoft Word, Excel, PowerPoint, Outlook, data entry, 10-key, typing, dispatch, document imaging, and standard office equipment. I have also worked with SAP ERP, eService, KMS, and call-center systems.
I am known for dependable attendance, sound judgment, professional communication, and a clean, organized approach to my work. I am seeking a stable position with a growing company where I can contribute my customer service, claims, administrative, and problem-solving experience while continuing to advance.
Provided phone and email support for registry, certification, and registered family care inquiries. Monitored voicemail and completed assigned administrative tasks.
Answered customer questions and addressed concerns related to Registered Family Care and the Central Background Registry.
Handled inbound and outbound calls for individuals who may have been exposed to or diagnosed with COVID-19. Interviewed clients to identify needs and entered information accurately into records.
Provided information regarding financial assistance and coordinated grocery orders, deliveries, and documentation for rent, mortgage, and utility assistance.
Supported health plan participants through inbound and outbound calls, claims processing, and client service activities. Verified Medicare claims and documented pertinent information in claim notes.
Applied CMS guidelines, contract benefits, CPT, ICD-9, ICD-10, HIPAA, and PHI requirements while investigating claims and identifying processing irregularities or trends.
Investigated insurance losses by taking statements from insureds, claimants, and witnesses and reviewing evidence, reports, and medical records. Identified coverage issues and made liability decisions.
Managed early-call bodily injury settlements, issued payments, negotiated with claimants and attorneys, and completed data entry, document imaging, and office support using SAP ERP.
Processed and adjudicated Medicare claims while reviewing client needs, contracts, and applicable benefit requirements. Entered detailed claim notes and investigated exceptions and claim-processing trends.
Applied knowledge of CPT, ICD-9, ICD-10, HIPAA, PHI, and contract benefits to ensure accurate and compliant claim determinations.
Provided customer service and support for prescription medication orders, claims requests, and member inquiries. Processed requests by phone, fax, mail, and data-entry systems.
Supported help desk, internet service, and connectivity questions while maintaining HIPAA and PHI privacy standards.
Delivered customer service, sales, order entry, shipping, receiving, and data-entry support in a temporary position. Assisted customers through phone-based service and technical support requests.
Provided help desk and internet connectivity support and protected client information through HIPAA and PHI practices.
Provided customer service, sales, marketing, order-taking, and customer interaction support for wireless customers. Entered data, supported shipping and receiving, and ordered supplies.
Assisted with technical support, help desk, internet connectivity, and Windows-related customer needs.
Performed inside sales, customer service, and marketing for dental products in an office and call-center environment. Contacted clients, scheduled appointments, processed orders, registered customers for courses, and dispatched outside representatives.
Supported dental shows and conventions, handled mail distribution and data entry, created Excel sales graphs and charts, and prepared product-related correspondence.
Delivered call-center customer service, package tracking, appointment scheduling, trace opening, freight processing, dispatch, sales support, and supply ordering. Used HP workstations, eService, KMS, and standard office equipment.
Managed dangerous goods shipping and receiving, hazardous-material documentation, spill cleanup, compliance audits, and safety training. Ensured compliance with FAA, IATA, OSHA, DOT, and FedEx policies for loading, labeling, packaging, securing, and transporting hazardous materials.
Provided table service, took customer orders, and processed cashier transactions in a fast-paced restaurant environment.
Maintained positive customer interactions while supporting efficient dining service.
Supported clients in a call-center setting by inputting and reporting laboratory tests and assisting with lab-result inquiries.
Performed dispatch, data entry, and phone coverage duties.
Handled inbound and outbound customer calls, data entry, billing support, and supply ordering.
Provided responsive call-center customer service and administrative assistance.
Certificate of Completion, Word Processing and Data Entry
Completed certification training in word processing and data entry.
High School Diploma
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