Bennisha Pelsey
Jacksonville,FL
Overview
12
12
years of professional experience
1
1
Certification
Work History
Customer Service Representative
Humana
10.2022 - Current
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
- Developed strong relationships with clients by providing empathetic support and understanding during challenging health situations.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
Advocates IV
Service Advocate
11.2016 - 10.2022
- Provide a customer friendly service experience for customers with questions or issues related to health care, health insurance (benefits, claims, premium payments, membership, billing, and enrollment) or other related topics
- Handle all inquiries related to the following: the Federal Market Place, CMS, ACA Compliance rules, individual enrollment, billing, reconciliation
- Resolve questions and issues to help customers utilize products, tools, services, and directly contribute to customer satisfaction and retention across 17-23 separate systems
- Assist members / groups with Cobra regulations and guidelines
- Served as a 'Universal' Service Advocate responding to inquires related to all segments including Medicare, Group, and Consumer (U65) across multiple functions (EM&B and Customer service)
- Partner with agents and the Agent Service Center and participate in identification of root cause resolution for any outstanding issues
- Serve as a subject matter expert for business requirements and automation development, corporate projects and workgroups, as well as training
- Resolve critical inquiries and ensure quality management of processes is in place
- Critically evaluate data through questioning, probing, and reasoning for process improvements
- Assist service advocates with less expertise by providing knowledge as well as experiences
- Review member enrollment files.
Customer Service Representative
Bank Of America
08.2012 - 11.2016
- Reduced call wait times by efficiently managing call queues and prioritizing urgent requests.
- Answered phone with friendly greeting to create positive inbound calling experience for customers.
- Handled high volume of inbound calls per shift to offer callers product and service information and generate quotes.
- Maintained high-quality service standards for all inbound calls, ensuring prompt and accurate assistance.
- Improved first-call resolution rates by effectively utilizing resources and available tools.
- Assisted team members with challenging calls, providing guidance and support to ensure positive outcomes.
- Responded to customer inquiries via telephone, email and live chat to provide updated information.
- Utilized active listening skills to identify customer needs and provide appropriate solutions.
- Delivered outstanding results under high-pressure situations by maintaining composure during difficult calls or high-volume periods.
- Enhanced communication skills through active listening, empathy, and clear verbal responses during customer interactions.
Education
HIGH SCHOOL DIPLOMA -
FLORIDA STATE COLLEGE
06.2012
Skills
- Account Management
- Active Listening
- Process Optimization
- Call Center Operations
- Customer Service
- Critical Thinking
- CRM Software
- Medical Terminology
- Time Management
- Business Administration
- Microsoft Office
- Administrative Skills
- Performance Improvement
- Claim Handling
- Type 45WPM
- System Documentation
- Inbound Phone Call Management
- Multi System Navigation
- CPT Coding
- Written Communication
- Medical Claims
- Health Insurance Benefit
- Payment Processing
- Banking Software Proficiency
- Audit Support
- Small business operations
- Creative Thinking
- Team Collaboration
- Products and Services Knowledge
- Customer Service-Oriented
- Relationship Building
Certification
- 100% Quality APT Certified
- Ulysses CPR
- BLS HIPPA
Timeline
Customer Service Representative
Humana
10.2022 - Current
Advocates IV
Service Advocate
11.2016 - 10.2022
Customer Service Representative
Bank Of America
08.2012 - 11.2016
HIGH SCHOOL DIPLOMA -
FLORIDA STATE COLLEGE
- 100% Quality APT Certified
- Ulysses CPR
- BLS HIPPA