Aisha Carter
Philadelphia,PA
Summary
Service-focused investigation specialist with a background in claims support, member issue resolution, and fraud review. Supports national and large local clients by handling eligibility, enrollment changes, claims questions, and provider verification while escalating complex concerns and keeping work organized across multiple priorities.
Overview
27
27
years of professional experience
Work History
Investigation Specialist
Independence Blue Cross
01.2005 - Current
- Manage service for national and large local 1000+ premier clients across medical coverage, claims, eligibility, enrollment changes, and terminations.
- Resolve member concerns regarding benefits, claims, eligibility, and enrollment status while supporting clear communication and issue resolution.
- Coordinate with medical providers and hospitals on patient account information, benefits, claims, and enrollment verification.
- Serve as liaison between marketing department and clients on complex benefit, claim, and enrollment matters; participate in weekly group calls and project work, and elevate client and team concerns to management.
- Investigated medical claims for Independence Blue Cross fraud and abuse concerns.
Sales Representative
Sprint PCS
08.2002 - 12.2004
- Assisted customers with their wireless service plans and billing issues.
- Informed customers of plan selections including: features, emailing, text etc.
- Handled warranty issues, technical and repair concerns.
Sales/Assistant Manager
Eastern State Wireless
11.1999 - 07.2002
- Informed customers of cellular products and services. Identified and resolved billing, contractual, and customer service issues.
- Recommended choices by listening to the needs of the customer.
- Up-sold equipment, accessories and services at a high degree.
- Effect billing changes and summarized all customers' requests for credit adjustments.
- Acted as liaison between customers and agents to solve equipment problems and performed other duties as required.
Education
Academic Studies - Business
George Washington High School
01-1996
Skills
- Assistant Manager Experience
- Computer Literacy
- Computer Operation
- Upselling
- Computer literate, proficient in Microsoft NT, Word, Excel, Lotus 1-2-3 and Internet Explorer 50, Power POINT, Netscape 40
- Superb listener and communicator who effectively conveys information orally and in writing
- Flexible team player who thrives in environments requiring ability to effectively prioritize multiple concurrent projects
- Analytical thinker with talent for identifying, improving and streamlining complex work processes
- Fraud investigation
Personal Information
Title: Sr. Account Representative - Independence Blue Cross
Timeline
Investigation Specialist
Independence Blue Cross
01.2005 - Current
Sales Representative
Sprint PCS
08.2002 - 12.2004
Sales/Assistant Manager
Eastern State Wireless
11.1999 - 07.2002
Academic Studies - Business
George Washington High School