Celestina Adewuyi
Lawrenceville,GA
Summary
Results-driven customer service professional with 8+ years of experience in claims processing, quality assurance, and provider/member support. Skilled in problem resolution, cross-functional collaboration, and staff training, with a proven track record of improving customer satisfaction and operational efficiency. Adept at analyzing complex issues, implementing effective solutions, and ensuring compliance with company policies. Proficient in Microsoft Excel, Outlook, and Word.
Overview
5
5
years of professional experience
Work History
Provider Services Representative
AmeriHealth Caritas
09.2023 - Current
- Managed and resolved complex claims requiring additional information, ensuring timely processing, and preventing payment delays
- Reduced processing errors by 95% through thorough quality audits and corrective action implementation
- Improved claims resolution time by 80%, streamlining workflows and enhancing response times
- Conducted staff training and cross-training, serving as a Subject Matter Expert (SME) to enhance team efficiency
- Collaborated with IT teams for User Acceptance Testing (UAT), contributing to system improvements and test script development
Member Services Representative
AmeriHealth Caritas
01.2021 - 09.2023
- Investigated and resolved member concerns, leading to a significant increase in customer satisfaction scores
- Consistently met or exceeded service level agreements (SLAs) for call resolution time, accuracy, and responsiveness
- Strengthened provider-member relationships through personalized assistance and accurate transaction processing
- Maintained compliance with all company policies and industry regulations while ensuring superior service
Customer Service Representative
Conduent
10.2020 - 01.2021
- Delivered high-quality customer service, handling high-volume inquiries with professionalism and efficiency
- Resolved customer issues quickly, navigating multiple software applications to find optimal solutions
- Implemented coaching feedback, leading to improved individual and team performance metrics
Education
Bachelor of Arts - Education
University of Benin
Nigeria07.2010
Skills
- Claims Processing
- Quality Assurance
- Provider Relations
- Member Relations
- Customer Satisfaction
- Conflict Resolution
- Problem-Solving
- Root Cause Analysis
- Training
- Team Development
- Microsoft Excel
- Microsoft Outlook
- Microsoft Word
- Time Management
- Process Optimization
- Claims processing
- Call center experience
- Money handling
- Customer account management
Timeline
Provider Services Representative
AmeriHealth Caritas
09.2023 - Current
Member Services Representative
AmeriHealth Caritas
01.2021 - 09.2023
Customer Service Representative
Conduent
10.2020 - 01.2021
Bachelor of Arts - Education
University of Benin
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