candice cole

customer service representative

About

Experienced Customer Service Representative with a demonstrated history of working in the insurance industry. Skilled in Lotus Notes, Microsoft Excel, Customer Service, Microsoft Word, and Leadership. Strong support professional.

Country

united states

City

boston

Industry

government relations

Skill

customer service, microsoft office, medical terminology, medicaid, appeals, u.s. health insurance portability and accountability act, health insurance, privacy law, long term care, data entry, public transport, writing, managed care, microsoft excel, oracle applications, lotus notes, microsoft word, microsoft access, sharepoint, leadership, federal and state regulations, data privacy, prior authorization, eligibility, coverage issues, customer service representatives, google maps, prescription drugs, medicaid managed care, state government, federal and state regulatory compliance, rightfax

Experience

member services representative

tufts health plan

2018-1 - 2019-1 · 1 yr 1 mo

Educated customers about their Health Insurance benefits, available plans, covered services, medications, and prior approval. Resolved complex coverage issues and filed appeals and other documentation as needed.

transportation specialist

maximus

2012-2 - 2017-5 · 5 yrs 4 mos

Used detailed knowledge of medical terminology to adjudicated Prescription for Transportation forms and Personal Reimbursement requests allowing members to access transportation for medical appointments. Responded to Transportation Escalations and urgent requests. Served as an internal and external point of contact to maintain accurate flow of information and resources.

premium billing specialist

maximus

2006-6 - 2012-1 · 5 yrs 8 mos

Resolved premium billing issues, Utilized Oracle to process adjustments and other financial transactions. Worked with EOHHS to maintain accurate and detailed information.

research specialist

maximus

2003-6 - 2006-5 · 3 yrs

Researched and resolved difficult cases involving member benefits and provider claim processing difficulties identified by Customer Service Representatives.