ตัวอย่าง Resume งาน BPO / Call Center (BPO) ฉบับที่ 129
Resume Example BPO #0129 ประมาณ 1260 คำ
เรซูเม่ฉบับนี้เป็นตัวอย่างสำหรับตำแหน่ง Claims Subject Matter Expert ระดับมืออาชีพ มีประสบการณ์รวมประมาณ 10 ปี เรานำมาวิเคราะห์เพื่อให้เห็นว่า โครงสร้างมีจุดเด่นอย่างไร และส่วนใดนำไปปรับใช้กับข้อมูลของคุณได้
จุดเด่นของฉบับนี้ แสดงประสบการณ์ทำงาน 10 ตำแหน่ง พร้อมหน้าที่และผลงานของแต่ละช่วงอย่างเป็นลำดับ
สิ่งที่ควรสังเกตในตัวอย่างนี้
- ประวัติงานต่อเนื่อง 10 ปี เห็นการเติบโตของตำแหน่งได้ชัด
- ประสบการณ์ 10 ตำแหน่ง ไล่ระดับจาก Junior ขึ้นไปจนถึงตำแหน่งปัจจุบัน
- Professional Summary กระชับ ใช้คำที่สื่อความสามารถได้จริง
- มีทักษะแยกเป็นหมวด 40+ รายการ ให้ HR เห็นสเปกครบถ้วน
Professional Summary
Experienced Customer Service Representative with over 10 years of experience Worked in Healthcare Industry for over 8 years with Humana, Passport and Excellus BCBS of NY Successfully trained seasonal associates for Open Enrollment and worked as a Client Subject Matter Expert for SHPS, Inc.
Experience
Claims Subject Matter Expert08/2016 - 11/2016
Mclaren Health Care
- Worked any other special projects assigned by management
- Responsible for meeting claims production goal of 200 claims per day
- Processed professional HCFA 1500 ambulance, anesthesia, labs, office visits etc. professional HCFA 1500
- Responsible for claims processing for the Medicaid plans for HMO 7
University Health and HMO 9 AHCSS
- Worked as a claims subject matter expert for Banner Health
Position
Aaa Of Southern California
- Responsible for duties in support of all departmental efficiencies as assigned by management
- Scheduled refills per the patients' plan benefit
- Keyed orders and sent for fulfillment
- Processed RX refills for customers
- Assisted with outbound calling to providers, patient and pharmacies to obtain additional info need to process the RX refill, Answered incoming calls
Patient Access Rep I06/2015 - 02/2016
Aaa Of Southern California
- Responsible for duties in support of departmental efficiencies which may include: but not limited to performing scheduling, registration, patient pre- admission and admission, reception and discharge functions.
- Verify medical benefits and eligibility with payers and calculate patient liability collection amounts
- Completes the whole patient financial clearance process; including educating patients on liability and collection of patient liabilities due.
- Completes all account documentation and enters the correct activity code when required.
- Secures insurance authorizations for services and updates account accordingly Performs payment reconciliation & secured payment entry in adherence to financial & cash control policies and procedures
Claims Subject Matter Expert/DST06/2015 - 06/2015
Jacobson Solutions/Insurance Consultants
- Worked as a Claims Examiner for DST Solutions based out of Delaware Responsible for processing Commercial and Medicare Plans.
- Adjusted backlog claims using the clients claims system for adjudication
- Knowledgeable of Citrix platform for applications.
- Utilized Claims Matrix to determine authorization for Delivery, Well baby Newborn, Inpatient Claims, Nursing Home etc.
Claims Examiner06/2014 - 04/2015
First Source Solutions
- Worked as a Claims Examiner for client Kaiser Permanente Southern California. Responsible for data processing incoming Hospital UB's for Medicare/ KPSA Plan. Contract interpretation to validate proper payment logic for claim adjudication. Identify billing and coding errors and submit documentation to provider's if necessary for corrected claims forms to be sent in with the Medicare compliance guidelines. Adjudicate Replacement, Late charge claims etc. accordingly per client's guidelines for processing.
- Proficient in Microsoft Word, Excel, Power point, Outlook, Internet Explorer, CMS Pricers, DRG Calculator, ICD-9, CPT, Basic Office Systems and various web applications
Claims Subject Matter Expert04/2013 - 04/2014
Jacobson Solutions/Insurance Consultants
- Worked as a contracted claims expert for Excellus BCBS of NY
- Responsible for claims processing for the HOME Commercial, Medicare and Medicaid plans
- Worked any other special projects as assigned by management.
- Processed claims with the HOST side of the plan updating provider files and credentials to support claims adjustment.
Provider Claims Service Unit Representative I02/2008 - 10/2012
- Responsible for immediate responses to incoming provider calls regarding claims issues. Process incoming correspondence from providers on claims issues that need to be resolved for Passport Health (Medicaid) and Passport Advantage.
- Reprocessing claims as identified through incoming phone calls or submitted by provider relations staff.
- Identifying systematic and procedural issues resulting in claims processing errors and initiating action to resolve those issues.
- Documenting calls, problems, and resolutions for future reference
- Proficient in Microsoft Word, Excel, Power point, Outlook, Internet Explorer, Facets, IKA Systems, CMS Pricers, DRG Calculator, ICD-9, CPT, Basic Office Systems and web application Worked special projects as assigned by management
Position
SHPS, Inc.
- Answered incoming calls regarding eligibility, claims processing, and billing inquires. Administered employee group benefits for retirees, active, long term disability, and cobra participants
- Resolved Issues for billing, carrier eligibility, etc.
- Organized special projects such as web inquiry responses, updating accurate information in our knowledge base customer service tool as assigned by management
- Team lead/Initiated training for full-time and temporary associates of ongoing call center and open enrollment.
- 03/2001 to 01/2003 Customer Service Claims Specialist-Chicago Medicare/ Commercial/ Medicaid Humana, Inc. - City, STATE
- Supported Chicago Medicare, Medicaid and Commercial Markets
- Received inbound and outbound calls from insured members, clients, brokers, agents and providers
- Mailed any related correspondence such as enrollment material, forms and brochures to members.
- Processed medical claims that needed adjustment
- Knowledgeable of DRG, ICD-9, CPT coding
- Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment.
- Accurately documented, researched and resolved customer service issues.
- Managed high call volume with tact and professionalism.
- Acted professionally and patiently when addressing negative customer feedback.
- Resolved service, pricing and technical problems for customers by asking clear and specific questions.
- Effectively managed a high-volume of inbound and outbound customer calls.
Claims Examiner06/2014 - 04/2015
Firstsource Solutions/ Outsource BPO
- Worked as a Claims Examiner for client Kaiser Permanente Southern California. Responsible for data processing incoming Hospital UB's for Medicare/ KPSA Plan. Contract interpretation to validate proper payment logic for claim adjudication.
- Identify billing and coding errors and submit documentation to provider's if necessary for corrected claims forms to be sent in with the Medicare compliance guidelines.
- Adjudicate Replacement Bill Type, Late charge claims etc. accordingly per client's guidelines for processing. Proficient in Microsoft Word, Excel, Power point, Outlook, Internet Explorer, CMS Pricers, DRG Calculator, ICD-9, CPT, Basic Office Systems and various web applications
- Precisely completed appropriate claims paperwork, documentation and system entry. Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge. Resourcefully used various coding books, procedure manuals and on-line encoders.
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and party requirements regarding billing.
Education
- Bachelor of Science: Psychology · Psychology/Christian Counseling · Administration · Advocacy · Case Management · Community Relations · Counseling · Mental Health Services Programming
- Certification in Medical Coding May 2017
- Ashworth College
Skills
HCPCS Coding GuidelinesUnderstands anesthesia codingUnderstands insurance benefitsDRG and PC groupingAmbulance coding familiarityExcellent problem solverMedical terminology expertOffice support (phonesfaxingfiling) - Excellent verbal communicationAdept multi-taskerfiling)Fast LearnerRecords management professionalOffice management professionalExcellent verbal communicationbalanceBasicbenefitsbillingbrochuresCalculatorcall centerCMSCPT codingCPTcreditclientclientscustomer serviceformsInternet Explorerteam leaderMicrosoft AccessExcelOfficeOutlookPowerPointPower pointWord
สรุปว่าจะได้อะไรจากตัวอย่างนี้
ตัวอย่างนี้ช่วยให้เห็นแนวทางการเขียนเรซูเม่สำหรับตำแหน่ง Claims Subject Matter Expert ประสบการณ์ 10 ปี โดยเปิดด้วยบทสรุปที่บอกจุดเด่นของผู้สมัคร ตามด้วยประสบการณ์ทำงาน 10 ตำแหน่ง และข้อมูลการศึกษาที่จำเป็น พร้อมทักษะที่เกี่ยวข้องกับงาน คุณสามารถนำลำดับและวิธีนำเสนอไปปรับใช้ โดยเปลี่ยนรายละเอียดให้ตรงกับประสบการณ์จริงของคุณ
อย่างไรก็ตาม เรซูเม่ที่ชนะต้องเขียนให้ตรงตำแหน่งที่คุณสมัครโดยเฉพาะ ตัวอย่างนี้คือต้นแบบ ไม่ใช่สำเนา ทีมเรซูเม่ของเรารับเขียน Resume และ Cover Letter ภาษาอังกฤษให้โดดเด่นจากคู่แข่ง ส่งงานใน 2 วัน รับประกันความพึงพอใจ