Summary
Overview
Work History
Education
Skills
Timeline
Generic

Aliza Allen

Monroe,NC

Summary

Experienced in customer interactions and issue resolution, leveraging effective communication and empathy to establish strong relationships. Proven track record of high customer satisfaction and fostering loyalty. Committed to ensuring every customer is fully satisfied through exceptional service and support. Proficient in customer service best practices, adept at exploring solutions for unique customer need

Overview

6
6
years of professional experience

Work History

Healthcare Customer Service Representative

Aetna
08.2023 - 10.2025
  • Conduct outreach to providers when members receive balanced bills to clarify responsibilities.
  • Engage in outreach with pharmacy vendors to address members' inquiries about medication coverage.
  • Provide outreach to members with updates on the status of pre-authorizations and appeals submitted by their healthcare providers.
  • Process 60-80 medical charts daily, ensuring accuracy and compliance with regulations.
  • Promote awareness of ACA provisions that increase access to affordable health insurance for individuals and families.
  • Educate clients about the different Medicare Advantage plans available, including coverage options and network providers.
  • Reprocess claims that were initially processed incorrectly to ensure accurate billing.
  • Review CPT and diagnosis codes to verify if claims were billed as preventive services.
  • Fax providers' explanations of benefits to outline member responsibilities.
  • Attach relevant member documents related to claims for proper processing.
  • Update members’ primary care physician information as needed.
  • Assist in locating in-network providers covered under members' policies.
  • Inform members about out-of-network providers and their implications.
  • Explain members' benefits, including deductibles and coinsurance.
  • Guide members on how to navigate the Aetna member website effectively.
  • Provide information on the pricing of medical services to members.
  • Process stop payments and reissue checks to members and providers as required.
  • Schedule appointments with healthcare professionals for clients when necessary.
  • Resolve conflicts among parties involved in a client's care plan to ensure seamless coordination.
  • Send ID cards to members to facilitate access to services.
  • Update members’ coordination of benefits information for accurate coverage.
    Email eligibility letters to members to clarify their benefits

Healthcare Customer Service Representative

TTEC
02.2020 - 08.2023
  • Responded to inbound calls from patients regarding coverage, billing, medical supplies, and transportation needs.
  • Conducted outbound calls to doctors’ offices, pharmacies, and insurance companies to resolve patient issues.
  • Distributed Medicare ID cards to patients.
  • Assisted patients in finding new doctors, pharmacies, and dentists based on their insurance plans.
  • Supported patients with Dual Complete, Commercial, Medicare Parts A, B, and D, and Medicaid insurance.
  • Communicated with doctors and patients via email and fax.
  • Verified patients' prior authorizations.

Education

High School Diploma -

Forest Hills High School
Marshville, NC

Skills

  • Medical coding
  • Insurance verification
  • Claims processing
  • Benefit explanation
  • Compliance management
  • Customer relationship management
  • Empathy
  • Effective communication
  • Time management
  • Microsoft Office Proficiency
  • Active Listening
  • Patience
  • Adaptability
  • Problem solving
  • Tenacity
  • Positive attitude
  • Appointment Scheduling

Timeline

Healthcare Customer Service Representative

Aetna
08.2023 - 10.2025

Healthcare Customer Service Representative

TTEC
02.2020 - 08.2023

High School Diploma -

Forest Hills High School

Similar Profiles

CREATE PROFILE