Category: ADVOCATE

         FAMILY ADVOCATE       Professional Summary     A motivated professional with practical, analytical, and operational skills with resourceful problem solving. Communicative and personable, will learn and adapt quickly. Hands on, follow directions, and serve internal and external customers with poise and professionalism.       Skills         Strong interpersonal skills  MS Word, MS Excel, MS Powerpoint  Outlook  Benefit servicing systems: ICUE, Facet, ISET  Customer service management expertise  Citrix, medical benefit and claim systems: KL library, LINX  Case Management  Medical Terminology Records (VLookup, Pivot Tables, etc)   Team leadership  Team liaison  Self-motivated  Extremely organized  Client assessment and analysis  Risk management processes and analysis  Staff development     Negotiation competency  Active Listening skills  Seasoned in conflict resolution  Courteous demeanor  Employee relations specialist  High customer service standards  Troubleshooting skills  Telecommunication knowledge           Work History      Company Name    Family Advocate  //  City  ,   State  //  May 2014   to   Current     Provide excellent customer service by responding to customer interactions via the telephone, email, or internet, in a professional, courteous, accurate manner while recording a brief overview of communication.   Resolves customer inquiries and concerns with first call resolution; assist with the members needs regarding benefits, eligibility, claims, financial spending accounts, health reimbursement accounts, and correspondence.   Answers customer's questions to help guide and educate them through selecting the best benefit plan options, maximize the value of their health plan benefits by helping them understand and select quality care providers. 
Intervene with care providers (doctor's offices) on behalf of the member to assist with appointment scheduling or connections with iternal specialist for assistance.   Encourages self-sufficiency by assisting members in navigating company websites, cell phone applications, and tools.   Take ownership of each call to build rapport by providing resolutions on behalf of the member in real time.   Creates, generates, and initiates request for customer callbacks to allow research and follow-up with the customer.   Research complex claims issues across multiple databases and work with support resources to resolve customer issues in addition to collaborating with other departments to resolve escalated issues.   Provide benefits education and status on previously submitted pre-authorizations or pre-determination requests.   Exceeds the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance.   Participates in and supports the development and implementation of special projects. 
Research and solve claims and billing issues.   Helps members with eligibility and benefits coverage questions. 
Interfaces with insurance carriers, physicians, hospital and other healthcare providers.         Company Name    Patient Care Advocate  //  City  ,   State  //  January 2008   to   May 2014     Maintained confidentiality and compliance standards at all times.  Met with patients and families to discuss care and plan of action for future.  Maximized preventative care utilization to reduce hospital burden and help eliminate readmissions.  Provided subject matter expertise in case management and related procedures.  Resolved issues such as billing or communication problems that could affect care.  Increased utilization of preventative care to reduce readmission.  Updated documentation and reports detailing patient activities, care actions and hospital determinations.         Company Name    Resident Director/Advisor  //  City  ,   State  //  May 2004   to   July 2007     Coached students on useful life and personal care skills.  Performed several administrative duties, including room transfers, incident reports and maintenance requests.  Encouraged a community atmosphere by implementing educational and social programs.  Attended, participated and contributed to monthly staff meetings addressing resident needs.  Mentored and supervised groups of 56 residents.  Mediated and provided professional conflict resolution in a timely fashion.  Counseled peers on career, academic and personal concerns.  Led by example through mature behavior consistent with university regulations and rules.  Fostered students' commitment to lifelong learning by connecting course materials to broader themes and current events.  Demonstrated a continued commitment to undergraduate teaching through full participation in the college community.         Education      Master of Chiropractic   -       Life University  //  City  ,   State    //  2013          Bachelor of Science   -   Psychology    East Stroudsburg University of PA  //  City  ,   State    //  2007   Psychology       Skills      Administrative support: filing, researching  Consulting  Customer service, customer support, telephone  Data entry: MS Excell, MS Office, Outlook, MS PowerPoint, MS Word  Medical Billing and coding: ICD-9, ICD-10  Office management: phone skills, phone, typing