Ellen T. Adams
GARLAND,TX
Summary
To contribute dynamic customer service, administrative, team building, and organizational skills towards supporting the objectives of an organization that rewards reliability, dedication, and solid work ethics with opportunities for professional growth.
Overview
21
21
years of professional experience
Work History
Peer to Peer Coordinator
HEALTH ADVOCATE - BH UNIT
10.2011 - Current
- Determine eligibility for cases that the meet criteria for Peer to Peer reviews.
- Schedule Peer to Peer appointments between Medical Directors and providers. Maintain schedules and calendars for Peer t Peer Team.
- Provided comprehensive customer support through performance of a variety of activities including verification of benefits, pre-authorizations, corporate customer service, business processes, insurance administration, benefits administration and ECM Faxes.
ACCOUNT REPRESENTATIVE
HUMANA
08.2010 - 09.2011
- Processed and maintained PDP account system set-up and maintenance for clients as well providing support to clients and brokers.
- Actively researched pended claims for errors as a result of claim codes or codes.
- Proactive Guidance to members regarding benefits.
SR CUSTOMER ADVOCATE
HMC
08.2002 - 06.2010
- Received and reviewed incoming calls from providers and members.
- Supporting Nursing staff with customer inquiries and cases.
- Determine eligibility and process Preauthorization requests based upon information provided by hospital personnel, members and providers.
- Proficiently plan, coordinate and manage work with the ITHM Core Team and performing User Acceptance Testing (UAT) projects.
Education
Associates Degree - Business Administration
Richland College
Dallas, TX05.2015
Applied Associates Degree - Social Studies
Cambridge University
12.1988
General Lines Agent (Life, Accident, Health & HMO)
Texas Department of Insurance
09.2017
Skills
- Concierge oriented customer service experience
- Knowledge of medical terminology
- Knowledge of Business processes
- Excellent Communication skills
- Strong documentation skills
- Good Customer service skills
- Web and PC proficiency
- Outlook, BlueStar, BlueChip, ACE, EAA, MPUI, SUM
- PC proficiency including include Word, Excel, PowerPoint
Accomplishments
• Awarded the 2013 SDO 5-Star Award
• AIM Mentoring Program for 2013
• Member Phi Theta Kappa Honor Society
Timeline
Peer to Peer Coordinator
HEALTH ADVOCATE - BH UNIT
10.2011 - Current
ACCOUNT REPRESENTATIVE
HUMANA
08.2010 - 09.2011
SR CUSTOMER ADVOCATE
HMC
08.2002 - 06.2010
Associates Degree - Business Administration
Richland College
Applied Associates Degree - Social Studies
Cambridge University
General Lines Agent (Life, Accident, Health & HMO)
Texas Department of Insurance
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