Alina McCray
Crandall,TX
Summary
Communicative customer service professional motivated to maintain customer satisfaction and contribute to company success. History managing large amounts of inbound calls and sustaining satisfactory relationships with customers. Offers skill with outstanding active listening and multitasking abilities.
Overview
9
9
years of professional experience
1
1
Certificate
Work History
Claims Associate PIP/MPC (Hybrid)
State Farm
Richardson , Texas
09.2023 - Current
- Gather pre-claim handling information
- Provide customers with pre-claim handling mitigation information if needed
- Apply knowledge of state and federal laws, statues and insurance regulations through the claim handling process
- Leverage our Enterprise Claims System and other technologies and automated procedures
- Receive inbound calls as well as make outbound calls to policyholders and claimants
- Review and monitor work queues which may include task items, calendars, mail, messages, and new claims
- Complete investigative steps when needed to determine customer needs, next steps and explaining these decisions to the customer.
- Utilize technical navigation skills to access the claim handling system, digital phone and state specific resources.
Senior Customer Service Representative (Remote)
United Health Group, Optum
Dallas, Texas
11.2022 - 09.2023
- Serve as a resource or Subject Matter Expert for team members or internal customers
- Handle escalated calls, resolving more complex customer issues
- Demonstrate outstanding service to identify the source of the caller’s issue and work to resolve the inquires in a timely and professional manner
- Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics such as selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider
- Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
Connector Trainer / Document Specialist
Dyck-O’Neal
Dallas, Texas
09.2018 - 11.2022
- Pull up accounts in ADS
- Manually dial all active phone numbers on an account in ADS
- Transfer correct party contacts (CPC) to the appropriate Account Representative (Mortgage Collector)
- Document each account properly in ADS with the appropriate result code
- Manually call numbers to verify if they are disconnected
- Leave a message on a recorder when allowed
- Receptionist backup
Soft Collections / Campaign Spectrum
Etan Industries
Dallas, Texas
02.2018 - 06.2018
- Managed 300+ inbound and outbound calls per day and provided excellent customer service
- Answered questions, updated account information, accepted and posted payments, and documented activities
- Remained calm, stayed professional and provided exceptional service on calls, even when interacting with difficult individuals.
- Notified customers of delinquent accounts with attempt to collect outstanding amounts.
- Arranged for debt repayment and established repayment schedule based on customer finances.
Customer Service Representative
Nations Home Warranty
Dallas, TX
08.2016 - 03.2017
- Answered inbound calls, provide product information and enter customers information into database.
- Reviewed outstanding requests and redirected workloads to complete projects on time,
- Maintained up-to-date knowledge of company policies and warranty procedures
- Gathered paperwork and contacted customers to book appointments.
Verification Specialist
Zerochaos
Dallas, Texas
05.2015 - 05.2016
- Conduct research and verify factual background information on applicants for education, employment and professional references screening purposes.
- Document thorough and accurate notes on the status of each search or verification are attempted received, and documents attached.
Pharmacy Help Desk (Catamaran)
United Healthcare
Richardson, Texas
02.2015 - 04.2015
- Responded efficiently and accurately to inbound customer service calls from pharmacies and members for a large Pharmacy Benefit Manager.
- Fulfilled number of task, including providing pharmacies with overrides and technical support in processing claims, assisting providers with prior authorizations and walking members through using their online account.
- Input data into clients computer platform to keep records of all conversation in our call center in a comprehensible way compiling with HIPPA and governmental documentation requirements
Skills
- Insurance knowledge
- Policy Interpretation
- Claims Processing
- Claims Investigation
- Call Volume and Quality Metrics
- Remote Office Availability
- Documentation Review
- Microsoft Office
- Communication Platforms – Zoom, MS Teams, and Google Meet
- Call Documentation
- Customer Support
- Customer Service
- Quality Assurance
- Billing Adjustments and Refunds
- Typing Speed: 40 WPM
- Understanding Customer Needs
Timeline
Claims Associate PIP/MPC (Hybrid)
State Farm
09.2023 - Current
Senior Customer Service Representative (Remote)
United Health Group, Optum
11.2022 - 09.2023
Connector Trainer / Document Specialist
Dyck-O’Neal
09.2018 - 11.2022
Soft Collections / Campaign Spectrum
Etan Industries
02.2018 - 06.2018
Customer Service Representative
Nations Home Warranty
08.2016 - 03.2017
Verification Specialist
Zerochaos
05.2015 - 05.2016
Pharmacy Help Desk (Catamaran)
United Healthcare
02.2015 - 04.2015
TX ALL-LINES ADJUSTER LICENSE
Claims Adjuster Academy
Associate of Science - Healthcare Management
Ultimate Medical Academy - Clearwater
Education
TX ALL-LINES ADJUSTER LICENSE
Claims Adjuster Academy
06-2023
Associate of Science - Healthcare Management
Ultimate Medical Academy - Clearwater
Clearwater, FL07-2022
Certification
- Auto, State Farm - 2023
- Property, State Farm - 2023
Additional Skills
- Human Resource Management
- Organizational
- lmprovements
- lnterpersonal Professional Communications
- Business Operations Practice Structure, Leadership & Management
- Medical Administrative Procedures
- Healthcare Ethics
- HIPAA Compliance
- Accounting
- Payroll
- Appointment Scheduling
- Medical Terminology
- lnsurance Verification
- CMS 1500
- Processing Co-Payments
- UB-04
- Medical Records Management
- lnsurance Billing Procedures
- Insurance Claim Cycle
- Health Records Management
- Electronic Health Records (EHR)
- Electronic Medical Records (EMR)