Summary
Overview
Work History
Education
Skills
Job Preferences - Open To
Timeline
Generic

Charmaine Chaney

Barrackville

Summary

Detail-oriented and highly motivated Customer Service and Claims Specialist with over 10 years of experience in high-volume call centers and remote healthcare administration roles. Skilled in claims analysis, pharmacy benefits, provider support, and customer engagement across government and commercial sectors. Proficient in EMR systems, Five9, QNXT, Compass, and CRM tools. Adept at remote work dynamics, with a proven ability to meet KPIs and resolve complex issues efficiently and empathetically. Dedicated Customer Service Specialist providing skills to prioritize and multi-task in fast-paced working environment. Successfully works as part of team to reach personal and business goals. Known for successfully handling escalated customer support issues.

Overview

14
14
years of professional experience

Work History

Customer Service Representative (Remote)

Alorica
Fairmont
10.2023 - 05.2025
  • Handled 50+ inbound calls daily for Carelon Rx via Five9 ADT Care, servicing Anthem Blue Cross Blue Shield Commercial and Medicaid members.
  • Initiated prior authorizations, processed medication overrides, and filed appeals/grievances.
  • Updated member records via People Safe and Compass systems.
  • Communicated with providers/pharmacists to validate and deliver accurate pharmacy benefits.

VA Medical Claims Reimbursement Specialist (Remote)

UnitedHealth Group
Atlanta
10.2021 - 10.2023
  • Analyzed RHRP and VBA healthcare claims using QNXT system.
  • Managed claims adjustments, appeal resolutions, and provider credentialing follow-ups.
  • Identified billing issues and collaborated with internal credentialing teams.
  • Ensured compliance and fraud prevention through detailed documentation review.

Appointment Scheduler / Claims Reimbursement Specialist (Remote)

The Judge Group (UnitedHealth Group Contractor)
Atlanta
08.2020 - 10.2021
  • Scheduled COVID-19 tests/vaccinations using Carenet and EMR systems.
  • Transitioned to VA Claims Specialist role; processed 200+ claims daily.
  • Supported credentialing and recredentialing operations.
  • Delivered high-quality service while following HIPAA protocols.

Satellite Office Supervisor

United States Medical Supplies
Atlanta
05.2019 - 08.2020
  • Managed compliance and audits in satellite office operations.
  • Monitored credential renewals and coordinated with providers.
  • Experienced in Medicare Parts A/B/D, billing software, and prior authorizations.

Customer Service Representative

Radiant Systems Inc (DXC Technology Contract)
Tucker
01.2019 - 04.2019
  • Responded to 100+ daily calls regarding Medicaid benefits and 1095-B forms.
  • Assisted with replacement cards, benefits explanations, and password resets.

Customer Service Representative

Teleperformance Call Center
Fairmont
09.2011 - 11.2018
  • Managed 75-125 calls/day on benefits, enrollment, and claims for AARP/UHC members.
  • Processed billing inquiries and scheduled wellness/preventive care visits.

Education

High School Diploma or Equivalent -

North Marion High School
Farmington, WV

Skills

  • Remote Call Center Operations
  • Claims Adjudication
  • EMR/EHR Systems
  • HIPAA Compliance
  • Pharmacy Benefit Support
  • Medical Billing
  • CRM Software
  • Provider Credentialing
  • Medicaid/Medicare Knowledge
  • Customer Satisfaction

Job Preferences - Open To

  • Full-Time Remote
  • Temporary
  • Seasonal
  • Internship
  • Telework

Timeline

Customer Service Representative (Remote)

Alorica
10.2023 - 05.2025

VA Medical Claims Reimbursement Specialist (Remote)

UnitedHealth Group
10.2021 - 10.2023

Appointment Scheduler / Claims Reimbursement Specialist (Remote)

The Judge Group (UnitedHealth Group Contractor)
08.2020 - 10.2021

Satellite Office Supervisor

United States Medical Supplies
05.2019 - 08.2020

Customer Service Representative

Radiant Systems Inc (DXC Technology Contract)
01.2019 - 04.2019

Customer Service Representative

Teleperformance Call Center
09.2011 - 11.2018

High School Diploma or Equivalent -

North Marion High School

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