April Simmons
Atlanta,GA
Summary
To secure a position where I can utilize my customer service skills within a progressive organization. Dedicated Customer Service Specialist providing skills to prioritize and multi-task in fast-paced working environment. Successfully works as part of team to reach personal and business goals. Known for successfully handling escalated customer support issues. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. 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 different systems paired with outstanding active listening and multitasking abilities.
Overview
12
12
years of professional experience
Work History
Claims Liaison
Centene Corporation
Atlanta, GA
03.2020 - Current
- Built rapport and trust with injured insureds through effective customer service techniques which involved fair and prompt processing of claims.
- Escalated unresolved complaints or disputes to higher level staff members for further review.
- Researched medical claims for validity to resolve discrepancies.
- Actively participated in team meetings aimed at improving overall efficiency within the department.
- Resolved customer disputes regarding claims processing in a professional manner.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Exceeded customer satisfaction by finding creative solutions to problems.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Maintained updated knowledge through continuing education and advanced training.
- Recognized by management for providing exceptional customer service.
- Completed day-to-day duties accurately and efficiently.
Customer Service Representative
Altegra Health
ALPHARETTA, GA
12.2015 - 02.2020
- Interact with health plan members through outbound and inbound telephone contact to initiate and complete chart request
- Email providers’ office explaining information about members and request
- Comply with all company and department operational guidelines and policies
- Ability to work independently
- Demonstrates patience and empathy
- Ability to communicate effectively (verbal, written and listening skills)
- Driven and motivated to exceed individual and team goals
- Comply with all company and department operational guidelines and policies.
- Greeted customers in a friendly and professional manner.
- Delivered high levels of customer service in accordance with corporate standards.
- Completed day-to-day duties accurately and efficiently.
Customer Service Representative
Alorica
KENNESAW, GA
01.2014 - 01.2015
- Proven ability to take over 60 inbound phone calls every day to customers
- Proficient in providing information and sell items over the phone to customers
- Well versed in identifying customer needs and able to offer a solution quickly
- Expert in using the company’s database software for data entry purposes
- Provided callers with the information on the internet packages and promotions
- Resolved customer’s technical issues over the phone
- Generated tickets for problems that cannot be resolved over the phone.
Sales Associate
Marshalls
MARIETTA, GA
07.2013 - 09.2013
- Assisted in promoting new brands introduced to the market
- Developed strong relationships with customers
- Maintained cordial relations with existing and new customers
- Submitted timely and accurate reports related to the arrival of new stock or remaining supplies in the store
- Maintained accounts of sales made, new orders, cash transactions and customer details
- Superintended the condition of the store and ensured proper maintenance, for optimum customer appeal.
Sales Associate
Home Depot
RAHWAY, NJ
03.2012 - 07.2013
- Assist customers with returns, purchasing store protection plans and service packages
- Scheduling in-home services via online interface
- Answer telephone inquiries from customers and stores regarding the status of units and other service issues
- Handling and resolving customer complaints
- Obtaining and evaluating all related information in order to handle inquiries and complaints
- Assisted and encouraged customers in selecting and purchasing required products in a retail environment
- Advised and helped locate appropriate merchandise
- Answered and addressed customers’ questions
- Provided information concerning specifications, warranties, financing.
Education
High School Diploma -
Springfield Central High School
Springfield, MA06-2011
Skills
- Data entry, type 25-35wpm, excellent verbal and written communication skills
- Claims Review
- Teamwork and Collaboration
- Eligibility Determination
- Insurance Claim Forms Review
- Customer Service
- Reporting Skills
- Documentation Abilities
- Background in Insurance
- Insurance Terminology
- Understanding of Medical Terms
- Microsoft Office
- Medicaid Knowledge
- Critical Thinking
- Attention to Detail
- Claims Processing
- Information Verification
- Coverage Determination
- Documentation Skills
- Decision-Making
- Active Listening
Timeline
Claims Liaison
Centene Corporation
03.2020 - Current
Customer Service Representative
Altegra Health
12.2015 - 02.2020
Customer Service Representative
Alorica
01.2014 - 01.2015
Sales Associate
Marshalls
07.2013 - 09.2013
Sales Associate
Home Depot
03.2012 - 07.2013
High School Diploma -
Springfield Central High School