Alfrieda Williams
Richmond,VA
Summary
Customer Service Specialist with exceptional skill in client engagement, communication, consumer support, and problem solving. Proven ability to deliver individuals services designed to meet & exceed customer satisfaction
Overview
9
9
years of professional experience
Work History
Customer Service Representative
Apex Systems
Richmond, VA
11.2022 - Current
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Demonstrated excellent communication skills in resolving product and consumer complaints.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Educated customers on special pricing opportunities and company offerings.
- Fielded customer complaints and queries, fast-tracking for problem resolution.
- Upheld quality control policies and procedures to increase customer satisfaction.
- Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Set up and activated customer accounts.
Inbound/Outbound Que Associate
Aetna/CVS
Richmond, VA
05.2020 - 09.2022
- Performs intake of calls from members or providers regarding services via telephone, fax, electronic data interchange.
- Utilizes systems to build research and enter member information.
- Screens requests for appropriate referral to medical services staff.
- Approve services in accordance with the benefit plan.
- Performs non-medical research including eligibility verification, combination of benefits, and benefits verification.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Promotes communication, both internally and externally, Plan Sponsors, and third-party payers as well as member, family, and health care team members.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Communicate with Case Managers when processing transactions for members.
- Maintain compliance with various laws and regulations, utilization review Accreditation Commission and National Committee for Quality Assurance standards, where applicable, while adhering to company policy and procedures.
- Places outbound calls to providers to obtain clinical information for approval of medical authorization.
- Use Systems, Trizetto Claims Processing System (QNXT), ProFAX, Provider Portal Prior Authorization Tool (ProPAT), and milliman, to communicates with nurses and medi- cal directors, when processing transactions or entering diagnosis or Current Procedural Terminology codes.
Inbound/Outbound Que Associate
LandSoft
Richmond, VA
05.2019 - 05.2020
- Maintained expert knowledge of client company products and services and equipped callers on team to successfully address 95% of customer questions.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality
- Communicate with Case Managers when processing transactions for members
Benefit Advisor
GoHealth
Charlotte, NC
08.2017 - 01.2018
- Guide consumers through the process of selecting the right health insurance and ancillary coverage
- Interpreted and applied the various guidelines for insurance carrier to applicant-specific health scenarios
- Achieved problem solving through research, collaboration and retention of knowledge
- Detailed oriented and able to meet quotas while maintaining full compliance with policies and Federal and State regulation
- Ability to communicate clearly and effectively with both consumers and co-workers
- Communicated the costs and benefits of major medical insurance plans through headset
- Scheduled and began the process of health insurance renewals for all existing clients
- Performed inbound and outbound call using two monitor screen for lead summary and five 9 application
- Utilized the consultative skills to assess the client’s needs
- Managed Aflac outbound and inbound calls.
Telesales Specialist
Xerox
Charlotte, NC
09.2016 - 02.2017
- Posses’ positive attitude and friendly manner
- Ability to ask probing questions to draw out additional customer wants and needs
- Answer customer inquiries of benefit and group insurance programs
- Follow a sales methodology to uncover customer needs and match appropriate products and service to their needs
- Enroll members into eligible coverage, change and update personal data
- Provide answers to customer coverage, also provide additional coverage as well as Special Enrollment Period,
- Access customer account information to determine promotion eligibility
- Enter sales information into scripting, software for reporting purpose
- Remain current on changes in the service pricing and procedure, order entry process, and sales promotion through completion of the required recommend training process
- Excellent communication and listening skills
Customer Care
United Health Group Customer Care, Optum
Concord, NC
07.2015 - 09.2016
- Help Medicare eligible individuals understand features and benefits of Medicare Advantage and Part D prescription plans.
- Utilize the internet to assist with Medicare approve discount drug programs and other related programs.
- Respond to relate inquires of benefits, eligibility, material request, and physician look up, pre-authorization.
- Explain explanation of benefits, and status check.
- Resolve complaints and refund request.
- Performed analysis lookup using Mysme.
- Make outbound calls and transfer special projects and phone work/use of head set throughout the day.
- Research of payment, billing, account balance questions with quality care.
- Respond to emails, written correspondence, order processing, and account maintenance.
- Navigate between multiple application and input data quickly.
- Credit card payment and calculate premium payment.
- Explain and interpret prescription drug plan to retirees.
Customer Care Sr. Assistant Rep
Xerox
Charlotte, NC
10.2014 - 02.2015
- Respond to customer inquiries using a computerized system in a call center environment.
- Responds to telephone inquiries and complaints using standard scripts and procedures.
- Gathers information, research/resolves inquiries and logs customer calls.
- Answer employer’s questions on hospitalization, worker’s compensation and pension.
- Verify, document and contact insurance carriers.
- Check Medicaid and private insurance in system, Enroll individuals into health plans.
- Communicates appropriate options for resolution in a timely manner.
- Informs customers about services available and assesses customer needs.
- Provides functional guidance, training and assistance to lower-level staff.
- Provide and troubleshooting support to lower level staff.
- Schedules work to ensures accurate phone coverage #CD# monitors priority of calls and shifts escalated calls to assure.
- Prepares standard reports to track workload, response time and quality of input.
- Assists in planning and implementing department goals and makes recommendations to management to improve efficiency and effectiveness.
Education
Master of Health Administration -
Kaplan University
11.2014
Bachelor of Health Administration -
University of Phoenix
01.2011
Associate of Science - Health Administration
University of Phoenix
Tempe, AZ02.2009
Skills
- Microsoft Office
- People skills
- Customer conflict resolution
- Account inquiry resolution
- Data confirmation
- Patient scheduling
- Registration documents
- Verifying eligibility
- Checking patient details
- Multitasking
Hobbies
- Reading
- Music
- Exercise
- Movies
- Garding
Timeline
Customer Service Representative
Apex Systems
11.2022 - Current
Inbound/Outbound Que Associate
Aetna/CVS
05.2020 - 09.2022
Inbound/Outbound Que Associate
LandSoft
05.2019 - 05.2020
Benefit Advisor
GoHealth
08.2017 - 01.2018
Telesales Specialist
Xerox
09.2016 - 02.2017
Customer Care
United Health Group Customer Care, Optum
07.2015 - 09.2016
Customer Care Sr. Assistant Rep
Xerox
10.2014 - 02.2015
Master of Health Administration -
Kaplan University
Bachelor of Health Administration -
University of Phoenix
Associate of Science - Health Administration
University of Phoenix