Sharon Ellis
Aliquippa,PA
Summary
Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results. Knowledgeable and dedicated customer service professional with extensive experience in Airlines and Health Insurance industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
18
18
years of professional experience
Work History
Customer Service Agent
Southwest Airlines
Pittsburgh, PA
08.2016 - Current
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Check customers in for their flights
- Board customers on the aircraft
- Tag customers luggage, enter claims into the system for lost luggage, research system to find lost luggage.
- Make reservations for flights, also enter the customer known traveler number for pre-check customers.
- Educated customers on company systems online and kioske.
- Verified identification and travel documents to efficiently board passengers for on-time departure.
- Operated PA system to make announcements regarding flight activity.
- Used airline computer system to create airline tickets and boarding passes.
- Answered incoming phone calls and developed friendly rapport with callers while answering questions, making recommendations and leading conversations to bookings.
- Provided passenger assistance at ticket counter and gate areas by issuing tickets, checking baggage and assigning seats.
- Resolved customer requests, questions and complaints by analyzing individual situations and determining best use of resources.
- Informed clients of essential travel information, such as travel times, transportation connections, medical and visa requirements to facilitate quality service.
- Provided high level of customer service to each person by engaging customer and using active listening and effective interpersonal skills.
- Managed online booking inquiries and assisted guests and travel partners with questions throughout entire booking cycle.
- Suggested various packages and amenities to guests, helping each find perfect accommodations to fit personal needs.
- Provided follow through on all calls with confirmations and dissemination of requested information.
- Managed and closed reservation calls to increase bookings by maintaining strong knowledge of resort products, services and facilities.
- Prepared customer invoices, accepted payments and processed refund and cancellation requests.
Medicare Case Worker
Aetna
Moon Township , PA
10.2015 - 06.2016
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Provided primary customer support to internal and external customers.
- Handled day-to-day customer contact via phones, faxes and emails.
- Investigated and resolved customer inquiries and complaints quickly.
- Contact and send appropriate information to the Medicare department, whenever the customer filed a complaint against the pharmacy for unfair billing.
- Write a report on behalf of the customer to P.A Medicare.
- Consulted with outside parties to resolve discrepancies and create expert solutions.
- Used company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
Provider Services Representative
Gateway Health Plan
Pittsburgh, PA
06.2008 - 10.2015
- Cross-trained and provided back up for customer service managers.
- Surpassed sales goals through implementation of effective marketing strategies.
- Developed, updated and organized [Software] databases to handle customer and [Type] data.
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
- Implemented and developed customer service training processes.
- Verified claims and made sure each claims submitted by the provider was paid correctly.
- Inbound calls from the providers verified ICD9 codes and DX codes billed on the behalf of the provider make sure they was paid correctly.
- If claim was not paid correctly, forward the claim to the appropriate department to update the claim an pay correctly.
- Managed claims payments from varies states, to make sure each claims was paid according to there state regulations.
Prior Authorization Specialist
Cigna
Pittsburgh, PA
09.2003 - 05.2008
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Maintained compliance with patient privacy and security regulations such as Pennsylvania.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Reviewed insurance coverage for patients to determine which party was liable for payment.
- Authorized surgical and specialist requests in accordance with applicable plan guidelines.
- Tracked referral submission during facilitation of prior authorization issuance.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Verified eligibility and compliance with authorization requirements for service providers.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
Education
Master of Science - Health Care Adminstration
University of Phoenix
Tempe, AZ08.2015
High School Diploma -
Aliquippa High School
Aliquippa, PA06.1986
Skills
- Creative Problem Solving
- Customer Account Management
- Multitasking and Prioritization
- Data Entry and Maintenance
- Building Customer Trust and Loyalty
- Customer Data Confidentiality
- Telephone reservations
- Transportation information
- Active Listening
- Training and Development
- Analytical and Critical Thinking
- Teamwork and Collaboration
- Good Telephone Etiquette
- Medical terms and procedure knowledge
- Health insurance industry knowledge
- Insurance claims processing
- Thorough claims reviews
- Healthcare Common Procedures Coding System (HCPCS)
- Benefits review
- Microsoft Word
- Emergency Response
- Claims
- Expenditure Authorization
- Decision Making
- Employee Training Program
- HIPAA Guidelines
- Performance Monitoring
- Patient Care Assessment
- Health Information Systems
Timeline
Customer Service Agent
Southwest Airlines
08.2016 - Current
Medicare Case Worker
Aetna
10.2015 - 06.2016
Provider Services Representative
Gateway Health Plan
06.2008 - 10.2015
Prior Authorization Specialist
Cigna
09.2003 - 05.2008
Master of Science - Health Care Adminstration
University of Phoenix
High School Diploma -
Aliquippa High School
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