Wendy Brown
Greensboro,NC
Summary
Experienced and results driven professional with over 20 years of expertise in the insurance industry. Proven track record of recognizing and addressing trends to optimize management and patient satisfaction while serving a diverse range of customers. Committed to delivering exceptional customer service and dedicated to ensuring customer satisfaction.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Member/Provider Customer Service Representative
UHC/Healthplex Inc
Uniondale, US
05.2021 - Current
- Respond to inquires from members and providers regarding benefits, claims, and any concerns or issues they may have.
- Distribute provider listings to ensure timely and accurate information specific to healthcare professionals.
- Answer phone calls from providers to address any issues or questions they may have regarding network development and advancement.
- Maintain a record of all phone calls, including details of conversations, to ensure transparency and accountability.
Provider Customer Service Representative
Aetna
High Point, US
10.2004 - 08.2014
- Managed inbound calls from providers, resolving claims/benefits issues promptly to ensure high customer satisfaction.
- Fostered strong customer relationships through friendly interactions.
- Promote use of website and voice response to get information about patients.
Medical Claims Representative
Aetna
High Point, US
09.2003 - 10.2004
- Ensured accurate billing by assigning precise ICD9 and diagnostic codes
- Efficiently collected crucial information from patients or physicians by promptly initiating claim pendency.
- Initiated internal review process for assessing claims accuracy.
Dental Customer Service Representative
Aetna
High Point, US
07.1996 - 09.2003
- Effectively communicated claim and benefit information to callers, resulting in expedited processing and enhanced customer satisfaction
- Conducted thorough inquiries to gather vital information on procedure necessity and supporting documentation, improving overall medical necessity assessments and claims accuracy
- Resolved customer inquiries and issues with multiple communication channels including telephone, letters, and online requests.
Dental Claims Processor
Aetna
High Point, US
01.1992 - 07.1996
- Contributed to precise medical evaluations by assessing x-ray results for clinicians
- Improved claims processing timelines by advocating for essential information required for claim validation.
- Evaluated patient eligibility for services based on plan documents and state regulations.
Dental Assistant II
Dr, Lewis and Associates
Greensboro, US
06.1991 - 01.1992
- Maintained and updated medical history records for orthodontic patients.
- Greeted patients upon arrival at the office and escorted them to an examination room.
- Ordered supplies necessary for daily operations of the practice.
- Sterilized instruments according to established guidelines and protocols.
- Performed x-ray procedures, installed new wires by placing spacers and removing rubber bands.
Dental Assistant II
Karen Barwick, DDS
Graham, US
06.1991 - 01.1992
- Instructed patients about postoperative instructions prescribed by their dentist.
- Sterilized instruments according to established guidelines and protocols.
- Provided chair-side assistance during dental procedures, including passing instruments to the dentist and holding suction devices.
- Assisted dentist in providing dental treatment to patients, including taking patient medical histories and vital signs.
Student Dental Assistant
Douglas Diabb, DDS
Burlington, US
09.1990 - 06.1991
- Greeted patients upon arrival at the office and escorted them to an examination room.
- Performed administrative duties such as scheduling appointments, answering telephones and updating patient records.
- Provided chair-side assistance during dental procedures, including passing instruments to the dentist and holding suction devices.
- Maintained a neat, clean and organized environment throughout the office.
Education
Associate of Arts - Healthcare Administration
University of Phoenix
Bachelor of Science - Healthcare Administration
University of Phoenix
Dental Assisting II Diploma -
Alamance Community College
Skills
- Achievement Driven
- Customer Centric
- HIPAA Privacy Regulations
- Microsoft Office Suite
- Product Knowledge
- Problem Solving
- Medical /Dental Terminology
- Excellent Communication
Certification
- Electronic Medical Records Certification
- Dental Assisting II Certification
- Long Term Care Certification
Accomplishments
- I have meet or exceeded the required metrics for the past 5 months.
Timeline
Member/Provider Customer Service Representative
UHC/Healthplex Inc
05.2021 - Current
Provider Customer Service Representative
Aetna
10.2004 - 08.2014
Medical Claims Representative
Aetna
09.2003 - 10.2004
Dental Customer Service Representative
Aetna
07.1996 - 09.2003
Dental Claims Processor
Aetna
01.1992 - 07.1996
Dental Assistant II
Dr, Lewis and Associates
06.1991 - 01.1992
Dental Assistant II
Karen Barwick, DDS
06.1991 - 01.1992
Student Dental Assistant
Douglas Diabb, DDS
09.1990 - 06.1991
Associate of Arts - Healthcare Administration
University of Phoenix
Bachelor of Science - Healthcare Administration
University of Phoenix
Dental Assisting II Diploma -
Alamance Community College
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