Organized, efficient and precise; excellent written and verbal communication skill, ability to prioritize assignments with urgency, executive decision-making skill, outstanding analytical skill, team building and relationship building skill; exemplary leadership and management skill, customer service, interpersonal skill.

1. LaKiesha Kelley
20140 Weybridge Apt #301R
Clinton Township, MI 48036
(586) 746-4069
kshkelley@gmail.com
SUMMARY OF PROFESSIONAL QUALIFICATIONS
Organized, efficient and precise; excellent written and verbal communication skill, ability
to prioritize assignments with urgency, executive decision-making skill, outstanding
analytical skill, team building and relationship building skill; exemplary leadership and
management skill, customer service, interpersonal skill.
AREAS OF CORE COMPETENCIES
● Microsoft Office Suite software and database applications; IKA
● Membership and Billing
● Project Management expertise
● Claims and inquiry processing
● Benefit Explainer, NCSW, Local 3270, MOS, Certificates and Riders, ASC
Modifications, Misource, Blue squared, WebDenis, Accumulator, Medco, etc.
PROFESSIONAL EXPERIENCE
Blue Cross Blue Shield, Detroit, MI 7/2012 to Present
CRS II / Group Processor II – Medicare Advantage
● Investigate, process, resolve and respond to member, provider and beneficiary
inquiries
● Load members into MetaVance via individual and groups
● Evaluate and process adjudicate claims and inquiries
● Developed New Business Large & Small and maintained existing non-standard
ASC and ERS groups Processed transactions to initiate group wide changes
involving retroactive effective dates, group transfers, mergers, and suffix splits.
Utilized multiple computer programs concurrently to effectively process multiple
groups per day
● Interact with underwriting, sales support, direct billing, production support, and
sales support on rate/billing issues.
Process group reinstatements without a lapse
● Working knowledge of Blue Connect, Selector, EOS, SMART, MetaVance, 3270
and Benefit Explainer
Accomplishments: Received recognition for Outstanding Provider & Member
Servicing; Selected as Member Face-to-Face service provider
Minacs at Express Scripts, Farmington Hills, MI 11/2011 to 07/2012
Pharmacy Help Desk / Patient Care Advocate
● Communicated with Pharmacist and Patients to process claims through PBS
system
● Processed remittance, reversed processed prescriptions and reimbursements
● Assisted pharmacist with payment errors
● Initiated first call resolution by updating patient information, processing request
for medical card, ordering medical supplies, drug coverage and assisting with
location of services.
L.KELLEY, P.1

2. Comcast Cable, Sterling Heights, MI 07/2010 – 10/2010
Customer Account Executive
● Provided exceptional customer service in areas of sales, quality, productivity,
billing, service concerns, rates and programming information while efficiently
responding to inbound customer calls
● Scheduled appointments for installation and service calls; resolved billing
disputes, misapplied payments, service/billing adjustments and complaints
● Educated customers and assisted with minor technical support
Belcan/Isuzu Commercial Trucks, Plymouth, MI 04/2008 to 07/2008
Customer Relations Specialist
● Partnered with Medium Duty Truck Assistance Center, Dealers, Isuzu Parts
Department and Service & Parts Managers to resolve and expedite vehicle repair
concerns.
● Made recommendation for case resolutions to the District Service Parts
Managers and Regional Managers when processing reimbursements, service
coverage letters, and service contracts
● Recognized emerging issues that impact Isuzu’s relationship with fleet customers
or impact the future sales of medium duty truck sales
Kelly Services, Contracted at Budco Company, Detroit, MI 09/2007 to 03/2008
Quality Control/Customer Service/Analyst
● Review and process confidential employee documents by ensuring the
documents meet healthcare eligibility guidelines
● Review agent processed documents for accuracy in accordance to company
policies and procedures and provide feedback for corrections
● Completed audits and verification processes for members to maintain
compliance for healthcare benefits.
Accomplishments: Promoted as Quality Analyst for Auditing within 1 month based on
performance reviews
DTE Energy, Southfield, MI 06/2000 to 11/2006
Business Consultant
● Resolved complex Residential and Commercial billing inquiries by researching
the customer’s concerns with scheduling field visits and requesting field
documentation to review for accuracy
● Negotiated payment arrangements for uncollected invoices; referred customers
to outside agencies for payment assistance; Processed request for new service
by processing commercial contracts and legal documents
● Assisted with productivity projects and training of Junior Customer Service
Representatives on new Company processes
EDUCATION
Lawrence Technological University, Southfield, MI All Certificates completed 11/12/2014
Lean Six Sigma Green and Black Belt Certification
Project Management Certification
L.KELLEY, P.2

3. L.KELLEY, P.3