Candice Hall
Dallas,TX
Summary
Personable and dedicated Customer Service Representative with extensive experience in Customer Service industry. Solid team player with upbeat, positive attitude 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, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.
Overview
17
17
years of professional experience
Work History
Appeals Specialist II
Blue Cross Blue Shield of Texas
Richardson, TX
12.2023 - Current
- Reviewed appeals submitted by patients and providers to ensure accuracy and compliance with policies.
- Analyzed medical records to determine if further information was needed in order to process appeals.
- Assisted customers with the appeals process, including providing guidance on how to submit an appeal.
- Prepared written responses for customer inquiries regarding their appeals status.
- Coordinated with internal departments to ensure timely resolution of appeals.
- Identified trends in the types of appeals received, and reported those findings to management.
Customer Service Specialist
Health Alliance Plan, HAP
Detroit, MI
09.2020 - 07.2023
- Documented conversations with customers to track requests, problems and solutions.
- Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
- Assisted customers in making payments on accounts and setting up payment plans.
- Upheld strict quality control policies and procedures during customer interactions.
- Built client rapport while accurately processing repair documentation and troubleshooting technical discrepancies through completion.
- Supported operational improvements and resolution of problems to deliver top-notch customer service.
- Informed customers about billing procedures, processed payments and provided payment option setup assistance.
- Reviewed account and service histories to identify trends and issues.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Consulted with customers to determine best methods to resolve service and billing issues.
- Cultivated impactful relationships with customers and drove business development by delivering product knowledge.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
Customer Service Representative
American Automobile Association Inc.
Dearborn, MI
01.2020 - Current
- Assessed customer needs and upsold products and services to maximize membership sales.
- Informed customers about billing procedures, processed payments and provided payment option setup assistance.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Reviewed account and service histories to identify trends and issues.
- Escalated customer concerns, store issues and inventory requirements to supervisors.
- Documented conversations with customers to track requests, problems and solutions.
- Answered 70+ inbound calls per day and directed to designated individuals or departments.
Concierge/Physician Access Coordinator
Henry Ford Health System
Detroit, MI
05.2017 - 01.2020
- Updated front desk's concierge spreadsheet to maintain most relevant visitor information.
- Rectified volatile situations quickly through active listening and effective communication.
- Greeted patients, visitors, and provided personalized support to meet unique needs and promote brand loyalty.
- Recognized by management for providing exceptional customer service.
- Supported Surgical Services department by compiling paperwork and taking detailed meeting minutes.
- Handled all delegated tasks, including checking patients in for surgical procedures for outpatient/inpatient stay.
- Answered 65+ inbound calls per day.
Underwriting Assistant
State Farm
Atlanta, GA
09.2016 - 04.2017
- Reviewed and evaluated Auto applications to approve, suspend or decline requests.
- Coordinated project materials by managing physical and digital files, monitoring spreadsheets and updating reports.
- Documented expected benefits and risks of Personal Lines Auto agreements.
- Responded to requests for immediate office support, such as data searches, office memo drafts or reference retrievals. Updated members demographics.
- Reviewed, classified, coded and rated applications to support Auto Personal Lines during busy periods.
- Collected and reviewed third-party reports, including driving record and credit score to support decisions.
- Reviewed and analyzed historical financial performance metrics.
- Performed data entry functions to track information such as payments, account updates and customer interactions.
- Conducted comprehensive analysis and evaluated risk to control underwriting loss.
Concierge/Physician Access Coordinator
Henry Ford Health System
Detroit, MI
01.2007 - 07.2016
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Greeted clients and provided personalized support to meet unique needs and promote brand loyalty.
- Updated front desk's concierge microsoft spreadsheet to maintain most relevant visitor information.
- Worked closely with guests such as celebrities or VIPs and always showed extreme professionalism and respect for personal privacy.
- Recognized by management for providing exceptional customer service.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Improved operations by working with team members and customers to find workable solutions.
- Earned reputation for good attendance and hard work.
- Improved customer satisfaction by finding creative solutions to problems.
- Answered 65+ calls per day.
- Supported Surgical Services department by compiling paperwork and taking detailed meeting minutes.
Education
Associate of Science - Applied Science
Wayne County Community College District
Detroit, MI06.2016
Skills
- Report creation
- Credit card payment processing
- Product organization
- Adaptive team player
- Microsoft Office expertise
- Call center experience
- Problem-solving abilities
- EPIC
- Data evaluation
- Documentation research
- Policy knowledge
- Coverage determination
- Insurance plan verification
- Medical terminology
- Documentation skills
- CPT and HCPCS coding
- Problem-Solving
- Teamwork and Collaboration
- Insurance Claim Forms Review
- Premium Collection
- Claim Amount Calculations
- Facets
- PEGA
- Guiding Care
Timeline
Appeals Specialist II
Blue Cross Blue Shield of Texas
12.2023 - Current
Customer Service Specialist
Health Alliance Plan, HAP
09.2020 - 07.2023
Customer Service Representative
American Automobile Association Inc.
01.2020 - Current
Concierge/Physician Access Coordinator
Henry Ford Health System
05.2017 - 01.2020
Underwriting Assistant
State Farm
09.2016 - 04.2017
Concierge/Physician Access Coordinator
Henry Ford Health System
01.2007 - 07.2016
Associate of Science - Applied Science
Wayne County Community College District
Similar Profiles
Kaitlyn ThompsonKaitlyn Thompson
Customer Advocate II at Blue Cross Blue Shield of TexasCustomer Advocate II at Blue Cross Blue Shield of Texas
Justin FloresJustin Flores
Claims Technician at Blue Cross Blue Shield of TexasClaims Technician at Blue Cross Blue Shield of Texas
Shannon Clark BSN RNShannon Clark BSN RN
Medical Reviewer II at HCSC, Blue Cross Blue Shield of TexasMedical Reviewer II at HCSC, Blue Cross Blue Shield of Texas
Sharnita HenrySharnita Henry
Primary Nurse Case Administrator at Blue Cross Blue Shield of TexasPrimary Nurse Case Administrator at Blue Cross Blue Shield of Texas
Antoine HightAntoine Hight
Distribution Center Manager at TH Marine SuppliesDistribution Center Manager at TH Marine Supplies