Hi, I’m
Ashley Larker
Benefits Specialist
Columbia,MD
Summary
Health plan benefits specialist and customer service representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires and providing customized solutions to build loyalty. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success. Knowledgeable and dedicated customer service professional with extensive experience in healthcare industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
17
years of professional experience
6
years of post-secondary education
Work History
Kaiser Foundation Health Plan of the Mid-Atlantic States, Rockville, MD
Member Services, Benefits Specialist
2012.11 - Current (11 years & 10 months)
Job overview
- Expertise as work from home benefits specialist, with over 10 years of customer service within the healthcare field with 99% monthly QA scoring average
- Served as first point of contact with expertise in Kaiser Permanente product knowledge to produce sales and promote member retention
- Expertise with health insurance plan models and benefits for Medicare Advantage for both individual and group plan policies, Medicaid plans, and other HMO, Self Funded, OOA commercial policies offered by Kaiser Permanente
- Mastery knowledge of medical claim structure, status review, and medical service coding
- Expertise with medical billing within the Patient Financial Services department
- Utilize various systems such as CHATS for interaction documentation and EPIC healthcare medical system to input, research, retrieve member coverage and health record information
- Served as support to Kaiser Permanente new hire training team based on skill and knowledge
- Completed annual employee training classes in relation to updated policy structures to ensure updated product knowledge and member retention
- Responsible for meeting personal and team monthly performance metric goals
- Averaging 50 incoming calls per day and maintaining a QA monthly average of 99%
- Utilized Ulysses customer service phone strategy to ensure member emotion and inquiry acknowledgement, provide genuine compassion throughout duration of call, and provide clear solutions with options
- Assisted Primary Care Team and Utilization Management Department with member referral requests and provided status updates to members and medical providers
- Utilized EPIC Healthcare EMR system to resolve member medical billing concerns and health chart account inquiries and Tapestry system to review incoming medical claims per HIPAA law compliance and Medicare billing guidelines
- Required to distribute Evidence of Coverage documents and construct benefit confirmation letters upon request by mail or electronically and provide explanation of such policy documents
- Provided education and clarification of federal laws in relation to patient rights to privacy daily
- Initiated visiting membership accounts for members originating from surrounding Kaiser Permanente regions
- Clarified policy benefit changes and updates with members and medical providers to ensure proper claim submission, processing and reimbursements
- Acted as a team lead to assist with content training and best call handling strategies for new and current CSRs.
- Recommended specific products and services in alignment with individual needs, requirements and specifications.
- Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Observed strict procedures to maintain data and plan participant confidentiality.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Educated customers about billing, payment processing and support policies and procedures.
- Liaised with sales, marketing, and management teams to develop solutions and accomplish shared objectives.
- Responded proactively and positively to rapid change.
- Reduced process inconsistencies and effectively trained team members on best practices and protocols.
- Promoted available products and services to customers during service, account management, and order calls.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Investigated and resolved accounting, service and service delivery concerns.
- Investigated and resolved customer inquiries and complaints quickly.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Maintained up-to-date knowledge of product and service changes.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Bolstered customer retention by creating and offering unique discount options and inspiring interest in new product lines.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Followed-through on all critical inter-departmental escalations to increase customer retention rates.
- Delivered prompt service to prioritize customer needs.
Arbitron Inc, Columbia, MD
Research Associate
2010.05 - 2012.11 (2 years & 6 months)
Job overview
- Developed and disseminated questionnaire/survey’s delivery to gather information regarding television and radio usage preferences for the purpose study for ratings statistics
- Obtained and analyzed household demographics to qualify and initiate members of the household to set up in home usage monitoring program
- Continuously met quota of households consenting review of usage daily.
Ruby Tuesday, Upper Marlboro, MD
Server
2009.03 - 2012.10 (3 years & 7 months)
Job overview
- Provided outstanding customer service as food service server within three Ruby Tuesday restaurant locations.
- Cultivated warm relationships with regular customers.
- Bussed and reset tables to keep dining room and work areas clean.
- Used slow periods to restock supplies, ice, trays, and delivery bags.
- Arranged and prepared tables for customers to offer memorable experiences to guests and foster repeat business.
- Upsold high-profit items such as appetizers and mixed drinks to enhance sales numbers.
- Seated customers in timely manner by managing reservations and waitlists skillfully.
- Utilized communication practices with kitchen staff to deliver customer meals in timely manner.
- Set positive tone for entire dining experience as first point of contact for incoming guests.
- Served food and beverages promptly with focused attention to customer needs.
- Resolved customer complaints promptly and professionally to maintain positive reputation.
- Maintained clean and organized dining areas to uphold restaurant hygiene standards.
- Shared knowledge of menu items and flavors, enabling customers to make personal decisions based on taste and interest.
- Maintained order efficiency and accuracy through clear communication with kitchen staff, earning numerous recommendations from satisfied customers.
- Strategically timed check-ins with customers to take orders and confirm satisfaction with meals after delivery, taking action to correct any problems.
- Displayed enthusiasm and promoted excellent service to customers, successfully increasing referrals, and walk-in business.
Wilson Center for Public Research, Landover, MD
Research Specialist
2006.06 - 2009.02 (2 years & 8 months)
Job overview
- Contacted union members to obtain demographic information and preferences of union members, used for the contract negotiations process
- Responsible for obtaining information via telephone survey.
- Monitored research data to assess accuracy, validity and integrity.
Education
Morgan State University
from Communications
2005.05 - 2008.05 (3 years)
Colorado Technical University
from Healthcare Management
2021.08 - 2024.05 (2 years & 9 months)
Skills
Proficient in Microsoft office, primarily word and excel
References
Kaiser Permanente Team Manager
Josette E Lawrence
301-437-9007
Timeline
Colorado Technical University
from Healthcare Management
2021.08 - 2024.05 (2 years & 9 months)
Member Services, Benefits Specialist
Kaiser Foundation Health Plan of the Mid-Atlantic States
2012.11 - Current (11 years & 10 months)
Research Associate
Arbitron Inc
2010.05 - 2012.11 (2 years & 6 months)
Server
Ruby Tuesday
2009.03 - 2012.10 (3 years & 7 months)
Research Specialist
Wilson Center for Public Research
2006.06 - 2009.02 (2 years & 8 months)
Morgan State University
from Communications
2005.05 - 2008.05 (3 years)
Similar Profiles
Erica LewisErica Lewis
Mental Health Assistant at Kaiser Permanente Of The Mid-Atlantic StatesMental Health Assistant at Kaiser Permanente Of The Mid-Atlantic States
Jarrel PhillipsJarrel Phillips
Associate Product Implementation Manager at Kaiser Foundation Health Plan IncAssociate Product Implementation Manager at Kaiser Foundation Health Plan Inc
Brad LindnerBrad Lindner
Facilities Services Supervisor at Kaiser Foundation Health Plan Inc.Facilities Services Supervisor at Kaiser Foundation Health Plan Inc.