Dorothy Smith resume November 2016
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/Dorothy Smith 21286 Danbury St, Woodhaven, MI 48183; Cell: 313-402-7759 Email: [email protected] Objective : am interested in a finding a position that will allow me to use my knowledge and experience that I have obtained by working the last 16 years as a supervisor, team lead, claims adjudicator and customer service rep. I am a good problem solver and have good problem solving skills. For the past 15 years I have a very high success rate of meeting or exceeding all my quality metrics and audits. I am proud to have received many “world class calls” and “kudos” for my excellent customer service and interpersonal skills. I am a motivated team player and involved in team building events. Work Experience Listed below are duties I perform in my current position as a BCN customer service representative (2007-current): Investigate, process, resolve and respond to member and provider inquiries via telephone, written correspondence or in person regarding benefits, eligibility, materials forms, ID cards, PCP changes, complex inquiries and quality of care issues. Educate new and existing members, providers, or beneficiaries concerning BCN policies and procedures and specific benefits through daily telephone inquiries. Document each contact through Macess. Record pertinent facts regarding inquiries and update appropriate files. In my previous Mcare position as a claims analyst (2000-2007), I was responsible for: Processing complex claims for all products Coordinated benefits including claims and adjustments Provided interpretation of certificate of coverage Before Mcare, I was a claims supervisor and team leader for Cascade Health Partners
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Transcript of Dorothy Smith resume November 2016
/Dorothy Smith21286 Danbury St, Woodhaven, MI 48183; Cell: 313-402-7759 Email: [email protected]
Objective: am interested in a finding a position that will allow me to use my knowledge and experience that I have obtained by working the last 16 years as a supervisor, team lead, claims adjudicator and customer service rep. I am a good problem solver and have good problem solving skills. For the past 15 years I have a very high success rate of meeting or exceeding all my quality metrics and audits. I am proud to have received many “world class calls” and “kudos” for my excellent customer service and interpersonal skills. I am a motivated team player and involved in team building events.
Work ExperienceListed below are duties I perform in my current position as a BCN customer service representative (2007-current):
Investigate, process, resolve and respond to member and provider inquiries via telephone, written correspondence or in person regarding benefits, eligibility, materials forms, ID cards, PCP changes, complex inquiries and quality of care issues.
Educate new and existing members, providers, or beneficiaries concerning BCN policies and procedures and specific benefits through daily telephone inquiries.
Document each contact through Macess. Record pertinent facts regarding inquiries and update appropriate files.
In my previous Mcare position as a claims analyst (2000-2007), I was responsible for:
Processing complex claims for all products Coordinated benefits including claims and adjustments Provided interpretation of certificate of coverage
Before Mcare, I was a claims supervisor and team leader for Cascade Health Partners (1996 - 2000) and was responsible for:
monitoring claims for accuracy and timely completion providing one-on-one guidance to claims examiners to achieve production standards achieved outstanding quality and exceeded required standards conducted on-the-job training for new employees independently resolved problem situations with high accuracy rates
Education1998-current: Henry Ford College Dearborn Michigan
MAJOR: Liberal Arts/ MINOR: Business
