Ameca Gargani
Kansas City,MO
Summary
Dedicated and experienced in managing and leading a diverse workforce, with a focus on achieving organizational goals and providing opportunities for training and advancement. Possessing a strong background in customer service, I excel at delivering exceptional support and efficiently resolving issues. Recognized consistently for my ability to foster team collaboration and achieve results in dynamic environments. Known for strong interpersonal skills and adaptability to changing needs, ensuring consistent customer satisfaction.
Overview
11
11
years of professional experience
Work History
Customer Service Representive-Advocate4me
United Healthcare
02.2023 - Current
- Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e
- Benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs))
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
- Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
- Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g
- Pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g
- Claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
- Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
- Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance
Owner
Tailored Cleaning LLC
10.2017 - 12.2022
- Managed day-to-day business operations.
- Developed and maintained strong relationships with clients, resulting in repeat business and referrals.
- Oversaw daily operations, ensuring all tasks were completed accurately and efficiently by team members.
- Increased customer satisfaction by implementing efficient business processes and providing exceptional service.
- Managed financial aspects of the business, including budgeting, financial reporting, and tax preparation.
- Consulted with customers to assess needs and propose optimal solutions.
- Hired trained, and managed a high-performing team of employees dedicated to achieving company goals.
- Negotiated contracts with suppliers for better pricing and terms, reducing overall costs for the business.
Medical and Dental Administration Billing and Claims Processer
IHC Health Solutions
01.2017 - 08.2017
- Responds accurately to telephone, fax and/or e-mail inquiries from agents, service provider’s employers and insured’s in a professional and courteous manner while documenting information provided in the company system(s)
- Makes outgoing calls, faxes and/or emails to provide information requested in a professional and courteous manner for resolution of inquiries
- Researches case files and consults with in-force administration and/or claims staff to determine the appropriate response to inquiries to ensure accurate information is communicated
- Takes accurate and detailed messages when resolution cannot be completed during the phone call so that the appropriate person/department is provided all the necessary information to research and resolve the inquiry
- Ability to read and interpret an insurance contract when responding to an inquiry from the caller
- To be knowledgeable and keep abreast with the products, state mandates and departmental procedures after the initial training period
- Have a working knowledge of the systems used to answer inquiries
- Meet alternate work schedule requirements as needed
- Complete call-back is to customers within 48 hours as required
- Knowledge of procedures for the claims and policy administration areas
- Performs similar job-related duties as assigned
Team lead/Supervisor
Servicom
02.2014 - 03.2016
- Issued instructions and assigned duties to workers
- Executed daily operations making sure that there are enough agents staffed for the day so cover requested number by client
- Supervised and coordinated activities of workers engaged in customer service activities
- Observed and evaluated workers' performance
- Resolved complaints and answered questions of customers regarding services and procedures
- Trained and managed over 500 individuals and achieved significant improvements in their productivity
- Trained and instructed employees
- Hired and discharged workers
- Communicated with other departments and management to resolve problems and expedite work
- Supervised 500 employees, scheduled work hours, resolved conflicts, determined salaries
- Successfully managed a 30-person team insuring that they complied with company rules and policy and provided the best customer service experiences
- Made recommendations to management concerning staff and improvement of procedures
- Planned and developed improved procedures
- Planned, prepared, and devised work schedules, according to budgets and workloads
- Prepared, maintained, and submitted reports and records, such as budgets and operational and personnel reports
- Responsible for controlling the floor and making sure that there was enough staff to cover the support that would be needed for the day
Education
Bachelor of Science - Health Care Administration
Capella University
Online09.2029
Certificate -
Dental Careers Foundation
Rockford, IL01.2008
High School Diploma -
Auburn High
Rockford, IL01.2000
Skills
- Complaint Handling
- Empathy Display
- Patience Maintenance
- Call center experience
- Professionalism
- Computer Skills
- Problem Resolution
Accomplishments
- Collaborated with team of advocates in the development of Change Champs with United Healthcare
- Achieved MRC 1,2 and 3 by completing all test with accuracy and efficiency.
References
Available upon request
Timeline
Customer Service Representive-Advocate4me
United Healthcare
02.2023 - Current
Owner
Tailored Cleaning LLC
10.2017 - 12.2022
Medical and Dental Administration Billing and Claims Processer
IHC Health Solutions
01.2017 - 08.2017
Team lead/Supervisor
Servicom
02.2014 - 03.2016
Certificate -
Dental Careers Foundation
High School Diploma -
Auburn High
Bachelor of Science - Health Care Administration
Capella University