Zurema C Pearson
Lithonia
Summary
Dedicated professional with over 10 years of experience in customer service/clerical support roles. Expert in customer care, communications, problem-solving, relationship building, and user training and support. Proficient in MS Office and various databases and software, with strong investigative, analytical, and organizational skills. Skilled specialist with a proven track record in delivering impactful results. Adept at team collaboration and flexible in adapting to changing needs. Experienced with specialized task execution and strategic implementation. Utilizes effective problem-solving techniques to enhance operational processes. Known for reliability and strong focus on achieving objectives.
Overview
20
20
years of professional experience
Work History
ECOB Specialist III
Anthem Blue Cross Blue Shield
12.2018 - Current
- Utilize internal queries and resource tools to initiate sensitive phone calls to carriers, members, groups, providers, attorneys, CMS, and Medicaid
- Update membership systems with investigation results for claim coordination
- Ensure correct forms are provided for Medicare enrollment
- Review claim history to reconcile processed, pended, or recovered errors
- Identify correct formulas to adjudicate impacted claims using multiple COB formulas as per state and federal guidelines
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
Utilization Management Lead
Anthem Blue Cross Blue Shield
06.2010 - 12.2018
- Managing of high-volume inquiries through both phone and email resolving an array of functions such as benefit questions, precertification processing, also but not limited to contract and benefit eligibility
- Act as a liaison between case management/non-clinical utilization staff and internal/external resources to handle member/provider issues
- Perform quality control audits for all employees, Employee reeducation, and a host of administrative duties
- Provide operational training to both associates and training department for accurate processing and processes
- Monitor and assign inventory as needed
- Track and report trends along with assisting associates with daily technical and processing questions
Customer Service Advocate
Anthem Blue Cross Blue Shield
07.2005 - 06.2010
- Processed dental and medical claims and created correspondence for decisions
- Managed high call volumes in a call center, processing requests from business consumers, patients, and MDs
- Facilitated training and work distribution for new hires
- Researched and resolved complex claim issues while maintaining monthly goals and metrics
Education
H.S. Diploma - General Studies
Hempstead High School
Hempstead, NY06-1993
Skills
- Dedicated World-Class Service
- Analytical Skills
- Problem Solving
- Fast Learner
- Proven Dedication
- Prior Investigative Experience
- Strong Communication Skills
- Healthcare Management
- Maintaining Goals
- HIPAA Certified
- Reports & Documentation
- Ability to Manage and Organize Priorities
Accomplishments
- Demonstrated strong investigative and analytical skills in claim coordination and error reconciliation.
- Effectively managed and organized priorities, and facilitated communication between departments.
Profile Snapshot
Dedicated professional with over ten years of experience in customer service/clerical support roles. Expert in customer care, communications, problem-solving, relationship building, and user training and support. Proficient in MS Office and various databases and software, with strong investigative, analytical, and organizational skills. With basic medical terminology and icd10 knowledge.
Computer Skills - Software Proficiencies
- Word
- Excel
- PowerPoint
- Access
- Outlook
- Internet Explorer
Timeline
ECOB Specialist III
Anthem Blue Cross Blue Shield
12.2018 - Current
Utilization Management Lead
Anthem Blue Cross Blue Shield
06.2010 - 12.2018
Customer Service Advocate
Anthem Blue Cross Blue Shield
07.2005 - 06.2010
H.S. Diploma - General Studies
Hempstead High School
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