Research and respond to inquiries, complaints and grievances received from numerous externalsources. Research, coordinate and resolve issues related to claims processing, eligibility,contracts, call history, benefits quotes, appeal decisions and decisions to reduce, modify ordeny services to members. may determine proper solutions to issues raised by legalentities, members, and state and federal regulatory agencies. Document inquiries andformulate solutions to problems and issues. Review databases and files used to maintainaccuracy, inputting corrections as necessary. Recognize and identify trends and presentsfindings to management. Approve/deny contractual disputes within limits of positionauthority. Collaborate and communicate verbally and in writing via phone, email, letter,etc. with external and internal sources regarding a variety of complaint and appeal issueswhich may include claims eligibility, contract issues, and/or the preparation andorganization of member appeals. Accurate and timely maintenance of system and case filerecords for use in reporting appropriate department data. Represent the appeals area inmeetings requiring team expertise and participation. Identify and communicate necessarycontract revisions/clarifications based on defects identified. Interpret member benefitbooklet contract language and/or provider contract language and apply it to the appealissue. Meet or exceed departmental goals of production, accuracy, and timeliness. Workcollaboratively with internal and external (including vendors) parties to thoroughlyresearch and respond to all cases. As needed, assist with reviewing, entering, andappropriately responding to new inquiries and requests. Review and research incomingmail and faxes to determine the correct recipient and triage expedited appeals requests.Serve as back up to other team members as needed

Provides inbound and/or outbound customer service support ensuring delivery of accurate,complete and timely information pertaining to member policies and coverage thoroughlydocumenting all calls. Conducts research to provide claims status, as well as investigatesroutine requests and escalates all call issues as required. Customer service reps serveboth Premera members and providers, providers include doctors, facilities (clinics,hospitals, skilled nursing facilities, etc.), and vendors for multiple geographic locations.My main active responsibility as a FEP CSR is to conduct research in order to provideinformation to both customer and business to business callers with 100% accuracy. I canaccurately research federal as well as Premera policies and procedures for both paymentand medical purposes, advising accordingly. My daily tasks involve researching andaccessing multiple platforms for information that pertains to any given task. The dualityof my research contrasts between benefit, claims and coordination of benefits (OPL)information provided to the customer as well as billing and policy correspondenceprovided to the medical professionals.

Position Verizon products and services to satisfy sales goals. Responsible for managing customerservice escalations through vendor paid labor resources. Diagnose, repair and maintain devicehealth across both customer and demonstration devices. Maintain product knowledge, setplanograms, assemble displays, technical troubleshooting, operate scissor lift, operate palletjack, install audio wiring, use impact and air tools, use hand tools, Microsoft office knowledge

Position Best Buy products and services to satisfy sales goals. Maintain product knowledge, setplanograms, assemble displays, mount TVs, technical troubleshooting, operate scissor lift,operate pallet jack, install audio wiring, use impact and air tools, use hand tools, Microsoft officeknowledge.

Position AT&T products and services to satisfy sales goals. Technical troubleshooting customerdevices. Maintain customer service relationship with repeat customers through follow upprocedures.