Experienced Supervisor leading team members on-time job completion. Assign tasks, train employees, provide feedback, mediate interpersonal conflicts and implement company procedures. Excellent communication and listening skills. Provide leadership and vision which drives teams to meet goals.
Overview
12
12
years of professional experience
Work History
Sedgwick
Customer Service Represenative
08.2023 - Current
Collaborated closely with team members to achieve project objectives and meet deadlines.
Provided support and guidance to colleagues to maintain a collaborative work environment.
Maintained updated knowledge through continuing education and advanced training.
Maintained accurate records of all claim activities including correspondence, reports, investigations, settlements.
Reviewed police reports, witness statements, accident reconstruction reports and other documents related to an incident.
Investigated and evaluated claims to determine liability and damages.
Reviewed medical records to assess liability and damages.
Participated in internal audits of claim files to ensure accuracy of data entry.
Analyzed employee eligibility for FMLA leave based on company policy and federal regulations.
Conducted research to obtain information related to FMLA claims processing as required.
Investigated property damage claims to determine coverage and liability.
Provided guidance to claimants regarding the claims process and documentation needed for payment processing.
Supervisor
Everise
08.2021 - 08.2023
Appeals
Handle escalations
Change Primary Care Provider
Process claims
Benefits
Authorizations
Prescriptions
Enrollment/ Dis enrollment
Find doctors/ Specialist
Schedule doctor appointments
Process payments
Plan change
Grievance
Patient intake paperwork
Setting appointments
Sending and receiving correspondence
Data entry
Maintaining referral files
Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
Monitored workflow to improve employee time management and increase productivity.
Evaluated employee performance and coached and trained to improve weak areas.
Achieved results by working with staff to meet established targets.
Resolved customer complaints in a timely manner while ensuring customer satisfaction.
Created new strategies for improving customer service standards within the organization.
Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.
Customer service representative
AppleOne
11.2020 - 02.2021
Provide members with benefits
Send out ID cards
Enter patient information
Go over authorizations
Set up patient transportation
Find providers and specialists
Process claims
Benefit
Authorizations
Prescriptions
Enrollment/ Dis enrollment
Find doctors/ Specialist
Schedule doctor appointments
Process payments
Plan change
Handled customer inquiries and suggestions courteously and professionally.
Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
Answered constant flow of customer calls with minimal wait times.
Answered customer telephone calls promptly to avoid on-hold wait times.
Updated account information to maintain customer records.
Aerotek
Medical Claims Processing
09.2019 - 04.2020
Medical claims for active duty military families and retirees
Fee claims for medical equipment
Reach out to providers
Add procedure and diagnosis codes to claims
Medical billing and coding ICD-10
Deny claims
Calculate payments
Created profiles for patients
Used DEFENSE ENROLLMENT SYSTEM
Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information
In addition, processors must keep meticulous records of claims and follow up on lapsed cases
Home healthcare
Skilled at working independently and collaboratively in a team environment.
Self-motivated, with a strong sense of personal responsibility.
Debt Collector
PRA
03.2019 - 09.2019
Keep track of assigned accounts to identify outstanding debts
Plan course of action to recover outstanding payments
Locate and contact debtors to inquire of their payment status
Negotiate payoff deadlines or payment plans
Handle questions or complaints
Investigate and resolve discrepancies
Create trust relationships with debtors when possible to avoid future issues
Update account status and database regularly
Alert superiors of debtors unwilling or unable to pay when necessary
Comply with requirements when legal action is unavoidable
Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
Achieved performance goals on consistent basis.
Maintained high volume of calls and met demands of busy and productive group.
Collected on delinquent accounts to reduce overdue balances.
Worked in call center environment handling manual and automatically dialed outbound calls.
Used scripted conversation prompts to convey current account information and obtain payments.
Resolved customer disputes and disagreements through professional, calm communication to find mutually beneficial solutions.
Negotiated payment plans with customers to prevent accounts from entering collections.
Laborer
People Ready
06.2018 - 03.2019
Construction / warehouse
Load and unload trucks
Calculate payments of shipments going out
Counting good and bad merchandise
Submitting invoices
Building new locations
Painting
Customer service Representative
Maximus
04.2018 - 06.2018
Handled customer inquiries and suggestions courteously and professionally.
Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
Answered constant flow of customer calls with minimal wait times.
Answered customer telephone calls promptly to avoid on-hold wait times.
Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
Maintained designated portfolio of customer accounts by contacting customers behind on payment obligations.
Provided exceptional customer service to patients, answering questions and addressing concerns.
Resolved billing inquiries and disputes in timely fashion.
Investigated insurance claims denials and appeals.