Jasmin Council
Taunton,Ma
Summary
The target is to utilize significant health insurance background, including member and provider experience, and system proficiency, to secure a position as an Claims Specialist
Overview
8
8
years of professional experience
Work History
Member Service Representative
Point 32 Health
10.2020 - Current
- Responsible for receiving, responding to, and directing member calls.
- Address member inquiries, questions, and concerns in all areas, and ensure members' issues and questions have been satisfactorily resolved.
- Explain to the member benefits, eligibility, claims, and enrollment.
- Describe the difference between an authorization and a referral.
Provider Service Representative
Tufts health plan
08.2017 - 10.2020
- Utilize necessary resources and navigate systems efficiently.
- Provide verification of members eligibility and benefits to providers office.
- Check the status of authorizations.
- Fax and email providers inquiries regarding appeals of medical claims.
- Assist providers with setting up and how to use the provider portal.
- Collected and returned unpurchased or returned items to correct shelf locations and arranged displays to promote sales.
Skills
- Strong computer skills and experience on a wide range of systems
- Extremely detail-oriented, and a strong team player
- Member correspondence
- Eligibility verification
- Problem solving
- Document processing
Accomplishments
Selected to be part of the welcome team; called new member to welcome them to the point 32 health family and briefly described benefits.
References
Genisa Miles, Member Services Supervisor, Point 32 Health, 1617-972-9400 EXT 60398
Timeline
Member Service Representative
Point 32 Health
10.2020 - Current
Provider Service Representative
Tufts health plan
08.2017 - 10.2020