Janetta Thomas
Blackwood
Summary
Highly enthusiastic and detail-oriented customer service professional with over 20 plus years of experience. I have in-depth knowledge of providing exceptional and detailed customer service. Excellent oral and written skills. Motivated to maintain time management skills and contribute to the company success. I have a positive attitude, hardworking and a solid team player.
Overview
21
21
years of professional experience
Work History
RETIREE ADVOCATE II
RETIREEFIRST
Mount Laurel
08.2025 - Current
- Advocated for retirees' rights and benefits through individualized support and case management, enhancing their overall well-being.
- Assisted retirees with claims inquiries and benefit-related issues, ensuring accurate information and timely resolutions.
- Provided retirees with detailed information about their plan benefits and eligibility criteria during consultations.
- Supported retirees during open enrollment periods and assisted with life-event benefit changes to ensure accurate coverage.
- Coordinated with insurance providers to resolve claim denials and billing discrepancies, facilitating smoother benefit access for retirees.
- Uphold confidential health information in compliance with HIPAA regulations.
ADJUSTMENT EXAMINER I
Capital Blue Cross
Harrisburg
06.2022 - 08.2025
- Assessed and modified insurance claims by verifying coverage benefits and payment eligibility within established guidelines.
- Uphold comprehensive understanding of medical billing codes, insurance policies, and industry regulations to optimize claim adjudication.
- Processed and documented claim adjustments using specialized software to ensure accuracy and compliance.
- Assessed eligibility for benefits by analyzing case facts and applying relevant laws to support fair claim decisions.
- Conducted detailed research and analysis to resolve discrepancies in claims, enhancing accuracy and efficiency.
- Documented findings and recommendations for claim resolution in reports.
PHARMACY TECHNICIAN
Rite Aid
Harrisburg
02.2023 - 02.2025
- Demonstrated expertise in preparing and dispensing medications accurately in a fast-paced medical environment while adhering to safety protocols and regulatory standards.
- Verified prescription orders to prevent errors and ensure compliance with medical guidelines.
- Addressed patient inquiries and educated on proper medication usage and potential side effects to enhance patient understanding.
- Trained and mentored new pharmacy technicians, promoting a knowledgeable and efficient team in a clinical setting.
MEDICARE APPEALS REPRESENTATIVE
Novitas Solutions, Inc.
Mechanicsburg
10.2017 - 06.2022
- Reviewed Medicare appeals from providers and beneficiaries, assessing in-house procedures, medical documentation, and compliance with CMS policies.
- Managed and resolved complex medical appeals by thoroughly reviewing patient records and insurance policies to ensure compliance with healthcare regulations.
- Maintained up-to-date knowledge of medical billing codes, insurance guidelines, and regulatory requirements to advocate effectively for claim approvals.
- Prepared detailed appeal letters supporting claim decisions to be sent to the party(s) that appeal.
- Communicated with healthcare providers regarding claim denials and required documentation.
- Ensured timely responses to appeals, adhering to organizational guidelines and enhancing overall appeal processing efficiency.
PROVIDER SERVICE SPECIALIST
Novitas Solutions, Inc.L
Mechanicsburg
10.2014 - 10.2017
- Utilized strong communication skills to educate providers on medical procedures, and billing processes, ensuring clarity and compliance.
- Delivered customer service by efficiently resolving inquiries and concerns, improving provider satisfaction in a fast-paced medical environment.
- Managed high-volume inbound calls, providing empathetic support to meet diverse caller needs.
- Maintained accurate patient records and confidential information, ensuring compliance with HIPAA regulations and organizational policies.
CUSTOMER SERVICE REPRESENTATIVE
Scientific Games
Middletown
05.2011 - 10.2014
- Handled inquiries and resolved issues related to lottery ticket purchases efficiently, resulting in positive customer experiences and repeat business.
- Processed high volumes of lottery ticket transactions accurately while ensuring compliance with regulatory standards, contributing to a trustworthy service environment.
- Maintained comprehensive knowledge of lottery ticket products and promotions to provide accurate information, enhancing customer satisfaction and loyalty.
TEAM LEAD
ACS, A Xerox Company
Harrisburg
09.2005 - 05.2011
- Led team of customer representatives, training and supporting staff to enhance service quality and achieve performance targets.
- Delivered exceptional customer service by efficiently resolving inquiries and complaints, enhancing overall client satisfaction and loyalty.
- Supported team members in reaching and sustaining individual and team goals through ongoing collaboration and guidance.
- Maintained up-to-date knowledge of DMV policies and procedures to provide accurate guidance and support to customers and team members.
Education
High School Diploma -
Harrisburg High
Harrisburg, PA06-1999
Associate of Science - Human Services
Harrisburg Area Community College
Harrisburg, PA06-2017
Some College (No Degree) - Human Services
Elizabethtown College
Elizabethtown, PASkills
- Claims assessment
- Claims advocacy
- Positive work ethic
- Case management
- Case file management
- Customer Service Expert
- Interpersonal skills
- Active listening skills
- Attention to detail
- Organization
- Multitasking
- Business correspondence writing
- Proofreading documents
- Team Leader
- Excellent interpersonal skills
- Positive attitude
- Documentation review
Awards
- Excellence Award in Customer Service
- 2008
- 2011
- 2015
Timeline
RETIREE ADVOCATE II
RETIREEFIRST
08.2025 - Current
PHARMACY TECHNICIAN
Rite Aid
02.2023 - 02.2025
ADJUSTMENT EXAMINER I
Capital Blue Cross
06.2022 - 08.2025
MEDICARE APPEALS REPRESENTATIVE
Novitas Solutions, Inc.
10.2017 - 06.2022
PROVIDER SERVICE SPECIALIST
Novitas Solutions, Inc.L
10.2014 - 10.2017
CUSTOMER SERVICE REPRESENTATIVE
Scientific Games
05.2011 - 10.2014
TEAM LEAD
ACS, A Xerox Company
09.2005 - 05.2011
High School Diploma -
Harrisburg High
Associate of Science - Human Services
Harrisburg Area Community College
Some College (No Degree) - Human Services
Elizabethtown College