Rukiyal Thomas
Houston,TX
Summary
Dedicated Network Management professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
21
21
years of professional experience
Work History
Customer Service Representative
Blue Cross Blue Shield Of Texas
Houston, TX
10.2000 - 08.2002
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Answered constant flow of customer calls with minimal wait times.
- Offered advice and assistance to customers, paying attention to special needs or wants.
Claims Examiner
Blue Cross Blue Shield Of Texas
Houston, TX
08.2002 - 06.2009
- Followed up with customers on unresolved issues.
- Processed and recorded new claims.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Acted as subject matter expert, answering internal and external questions and inquiries.
Provider Relations Representative
Blue Cross Blue Shield Of Texas
Houston, TX
06.2009 - 07.2021
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Identified network gaps and collaborated with Contracting Representative to fill deficiencies.
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction.
- Initiated physician and hospital orientations to support ongoing education of health care provider community.
Education
Lone Star Community College
Houston, Tx Skills
- PC Proficiency, including microsoft office
- Resolving Problems
- Self Starter
- Quality Standards and Protocols
- Building Rapport and Credibility
- Documenting and Recording Information
- Providing Information and Resources
- Contract Renewals and Development
- Provider Directory updates
- Claims processing and adjustments
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Success is often achieved by those who don’t know that failure is inevitable.
Coco Chanel
Timeline
Provider Relations Representative
Blue Cross Blue Shield Of Texas
06.2009 - 07.2021
Claims Examiner
Blue Cross Blue Shield Of Texas
08.2002 - 06.2009
Customer Service Representative
Blue Cross Blue Shield Of Texas
10.2000 - 08.2002
Lone Star Community College
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