Gamali Jones
Bronx
Summary
Motivated candidate aiming for full-time position to utilize skills and contribute to organizational improvement
Overview
16
16
years of professional experience
Work History
Customer Care Representative
Elevance Health/ Anthem Behavioral Health
12.2023 - Current
- Customer Support & Communication (Phone, Email, Chat)
- Analyze issues and provide information and solutions to customers. For complex issues, a CCR I might get assistance from co-workers or managers.
- Answer questions from members and healthcare providers regarding insurance benefits, eligibility, and claims.
- Documentation & Data Entry (40+ WPM, MS Office, Genesis Cloud)
- Handle high volumes of incoming calls, emails, and online chats while using multiple computer systems.
- Operate a computer to document information, activities, and database changes. Document inquiry outcomes for tracking and analysis.
Medical Claims Processor
United Healthcare Group
03.2021 - 07.2023
- Process 120+ medical/hospital Claims daily
- Review claims to ensure that there is no missing or incomplete information
- Determine eligibility, benefits level, external cob, icob, and resolve third party issues
- Route Specialty Claims to correct bucket
- Respond to emails immediately
Oral Surgeon/Periodontist Treatment Supervisor
Dental Specialties of NY
02.2013 - 03.2020
- Verify Insurance benefits
- Communicate with patients regarding outstanding balances, questions about their bills or treatment
- Evaluate patients x-rays
- Coordinate Treatment plan for each patient
- Set up CareCredit/ Credit Card or Cash as option for payment plan
- Manage payments from insurance and patient
- Control scheduling for 5 Specialist. Endodontics, Periodontics, Oral Surgeon, Pedodontist, Orthodontist
- Supervise call center staff
- Train new staff
Office Manager
Blue Dental Care
01.2010 - 11.2012
- Work with financing companies such as Care Credit, Chase Advance, Springstone
- Monitor and train staff
- Calculate and Collect Copays, Deductibles, Payments
- Verifying Insurance benefits
- Processing EOB’s, Posting Payments & Bill all insurance companies
- Knowledge of Easy Dental, Dentrix, Dexis
- Order office supplies
Head Beauty Advisor
Walgreens
10.2009 - 02.2011
- In charge of the whole cosmetic department
- Keep track of inventory for beauty products
- Start & Complete Resets and Revisions
- Promote Beauty product of the week
- Train Cashiers
Education
Diploma - undefined
City as High School
New York, NYSkills
- Proficient with MS Office, Claim Processing, Customer Service Skills, Type 40 wpm, Familiar with HCPC, ICD10, Call Center
Timeline
Customer Care Representative
Elevance Health/ Anthem Behavioral Health
12.2023 - Current
Medical Claims Processor
United Healthcare Group
03.2021 - 07.2023
Oral Surgeon/Periodontist Treatment Supervisor
Dental Specialties of NY
02.2013 - 03.2020
Office Manager
Blue Dental Care
01.2010 - 11.2012
Head Beauty Advisor
Walgreens
10.2009 - 02.2011
Diploma - undefined
City as High School
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