Mary E Giuliano
Bayville,NJ
Summary
Dedicated professional in customer service and health care with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
38
38
years of professional experience
Work History
Process Auditor
Horizon Blue Cross Blue Shield
Farmingdale, NJ
07.2002 - 07.2022
- Provide resolution to identified overpayments utilizing various methods ie: written correspondence, outbound calls to members or providers or adjustment to claims.
- Research claims for accuracy and resolve issue for accounts receivables or disposition of checks.
- Ensure accurate and timely resolution of inquiries via written or call inquires of claim payments , benefits or appeals.
- Follow up to any unresolved issues via outbound call, emails or faxes. ensuring claims submission to resolution accuracy
- 4/2007-7/2022
Senior Member Service Representative
Horizon Blue Cross Blue Shield Of NJ
Farmingale, NJ
05.2010 - 04.2017
- Assisted irate escalated customers every day with positive attitude and focus on customer satisfaction.
- Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions.
- Learned internal systems and related service role duties to provide skilled team backup in handling customer demands.
- Resolved concerns with products or services to help with retention and drive sales.
- Investigated and resolved customer inquiries and complaints quickly. Escalated issues and maintained escalated call center
- Assisted new hire training classes, handle escalated provider and member inquiries , complaints and appeals
- Maintained updated knowledge of internal processes and industry best practices to optimize service delivery
- Cross-trained and backed up other customer service representatives in all areas when needed
Member Service Representative
Horiozon Blue Cross Blue Shield
Farmingdale, NJ
09.2001 - 05.2010
- Provide excellent service to members through resolution of basic customer inquiries received by phone or written correspondence every day with positive attitude and focus on customer satisfaction.
- Assisted members with injuries via phone, fax, mail or email
- Initiate investigation process based on the nature of inquiry, (claim , member information, benefits, enrollment , appeals. Utilize all resources to quickly and efficiently resolve inquiries,
- Researched and rapidly resolved client conflicts to maintain key accounts STATE HEALTH BENEFITS , HEALTH CARE REFORM , and assisted other areas of Horizon learning all lines of business, managed care, etc.
Claims Processor
Horizon Blue Cross Blue Shield Of NJ
Farmingdale, NJ
07.1999 - 09.2001
- Responsible for the proper handling and distribution of hard copy documents that are submitted.
- Responsible for the initial review , scanning indexing and data entry of claims
- data entry of medical billing information into processing systems within prescribed time limits and quality standards.
Education
Certificate - Computer Help Desk
Cittone Institue
Edison, Nj07.2001
Certificate - Medical Transcription
OCEAN COUNTY VOC
Toms River, NJ06.1998
High School Diploma -
East Orange Catholic Hs
East Orange, NJ05.1981
Skills
- Complaint resolution
- Medical terminology knowledge
- Service standard compliance
- Professional telephone demeanor
Timeline
Senior Member Service Representative
Horizon Blue Cross Blue Shield Of NJ
05.2010 - 04.2017
Process Auditor
Horizon Blue Cross Blue Shield
07.2002 - 07.2022
Member Service Representative
Horiozon Blue Cross Blue Shield
09.2001 - 05.2010
Claims Processor
Horizon Blue Cross Blue Shield Of NJ
07.1999 - 09.2001
Certificate - Computer Help Desk
Cittone Institue
Certificate - Medical Transcription
OCEAN COUNTY VOC
High School Diploma -
East Orange Catholic Hs
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