ASHLEY HUNTER
Ocala,FL
Summary
Empathetic customer service professional in customer support, account management, and issue resolution. Recognized for high productivity, accuracy, and efficiency in completing tasks while maintaining exceptional service standards. Skilled in data entry, Microsoft Excel, communication, problem-solving customer experiences, resolving concerns effectively, and achieving organizational goals.
Overview
14
14
years of professional experience
Work History
Member Services Representative
Convey Health Solutions
Miramar, FL
07.2020 - 10.2026
- Resolved member inquiries regarding Medicare eligibility, enrollment, prescription drug benefits, and plan changes while providing accurate and timely assistance.
- Educated Medicare members on Part D prescription drug benefits, formulary tiers, coverage options, and copayment structures to promote understanding of prescription drug coverage.
- Guided members in understanding prescription coverage limitations and available alternatives to support informed decision-making.
- Coordinated prior authorization and formulary exception requests with healthcare providers to ensure timely access to necessary medications.
- Processed pharmacy claims and researched prescription coverage issues to ensure accuracy and compliance with Medicare Part D plan requirements.
- Recorded member interactions and claim inquiries in CRM and pharmacy claims systems to maintain accurate documentation and enhance service continuity.
Claims Representative
Humana
Plantation, FL
01.2016 - 07.2020
- Reviewed and processed medical, pharmacy, and Medicare claims to ensure accuracy, eligibility, and compliance with plan guidelines.
- Investigated claim discrepancies, resolving denials, payment errors, duplicate submissions, incorrect billing, and coverage-related issues to ensure accurate claims processing.
- Verified member eligibility, benefit coverage, deductibles, co-payments, coinsurance, and plan-specific requirements.
- Evaluated supporting documentation to confirm claim validity and maintain compliance with payer policies and processing guidelines.
- Reviewed and processed claim adjustments, reconsideration corrections, and appeals to achieve timely and fair resolution.
- Utilized claims-processing systems, CRM platforms, and health
Retention Customer Service Representative
T-Mobile
Sunrise, FL
05.2012 - 01.2016
- Delivered empathetic, professional customer service while balancing customer needs with company retention goals.
- Provided authorized account credits, discounts, adjustments, and loyalty solutions while partnering with management and internal departments to resolve escalated concerns and identify retention options.
- Managed account changes, upgrades, cancellations, suspensions, and activations to ensure seamless service continuity.
- Addressed customer inquiries on technical issues, sales opportunities, commissions, and account services to enhance customer satisfaction.
Education
Bachelor of Business Administration -
Broward College
Fort Lauderdale, FL01-2010
Medical Assistant -
Sanford-Brown Institute
Fort Lauderdale, FL01-2006
Skills
- Medicare eligibility
- Prior authorization
- Pharmacy claims
- CRM documentation
- Claims processing
- Benefit verification
- Member retention
- Account resolution
Personal Information
Title: Member Services Representative
Timeline
Member Services Representative
Convey Health Solutions
07.2020 - 10.2026
Claims Representative
Humana
01.2016 - 07.2020
Retention Customer Service Representative
T-Mobile
05.2012 - 01.2016
Bachelor of Business Administration -
Broward College
Medical Assistant -
Sanford-Brown Institute