Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

Chelsea Gagliardi

Chelsea Gagliardi

Summary

10+ years in customer service; both in-person and remote. I take pride in delivering a world-class customer experience without compromising efficiency, quality, or accuracy. Knowledgeable and extensive experience in customer-facing roles as we as high-volume, inbound call centers both involving conflict resolution, de-escalation, and high-stress environments while maintaining/exceeding company standards and ethics. Specialty in Medical Insurance and Medicare/Medicare Advantage policies. I aim to utilize these skills to fill the position with your company and help positively impact your company's success.

Overview

6
years of professional experience

Work History

Highmark BCBS WNY & NENY

Provider Services Representative
05.2023 - Current

Job overview

  • Responsible for speaking directly to provider offices regarding member coverage/quoting benefits and eligibility inquiries.
  • Researched prior authorization requirements/statuses, and initiate authorizations as needed.
  • Educate providers about billing, payment processing and support policies and procedures.
  • Handle appeal inquiries and ensure they're managed within expected timeline.
  • Research billing and claim inquiries; relaying correct data to provider inquiries regarding claim denials; expected to accurately determine if adjustment is needed based on member's plan as well as relevant medical policies.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Enhanced productivity levels by anticipating needs and delivering outstanding support.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.

UnitedHealth Care

Medicare Advantage Group-Retiree Plan Advocate
10.2022 - 05.2023

Job overview

  • Responsible for taking ownership and ensure first-call resolution
  • Utilize empathy and active listening to determine member's needs.
  • Built positive rapport with member's on every call to assist in maintaining UHC's high CMS Star Ratings.
  • Personally secured the highest UES (customer satisfaction survey) score rating within my team and maintained 100% documentation per CMS regulations.
  • Understood and thoroughly explained insurance plans and coverage to members.
  • Anticipated member's needs and made them my responsibility, such as calling a provider for clarification on a bill, or helped an individual find a specialist within their neighborhood.
  • Collected premiums on or before effective date of coverage.

Gi-Ro Dry Cleaner

Customer Service Advocate & Storefront Manager
08.2017 - 09.2019

Job overview

  • Responsible for independently managing storefront operations (open to close).
  • Built long-term, loyal customer relations by providing top-notch service and detailed order, account, and service information.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Developed and updated databases to handle customer data.

Education

UnitedHealth Group MyLearning

Medicare & Retirement Certification I, II, & III
01.2023

University Overview

Niagara University

Stock/Stock Option Certificate from Economics
05.2014

University Overview

Niagara University

Accounting Certificate from Accounting And Finance
05.2014

University Overview

Skills

  • Computer Proficiency / Toggling Multiple Programs
  • Medical Terminology / ICD-10 Knowledge
  • Time Management / Independent
  • Medical Billing / Claim Adjustment
  • Analytical / Naturally Empathetic
  • Medical Policy / CMS Knowledge & Guidelines
  • Policies and Procedures Adherence
  • Active Listening / Effective Communication
  • Comprehensive Knowledge of Medical Insurance Plans
  • De-Escalation Techniques
  • Flexible / Adaptability
  • Website Tech Experience / IT Assistance

Timeline

Provider Services Representative
Highmark BCBS WNY & NENY
05.2023 - Current
Medicare Advantage Group-Retiree Plan Advocate
UnitedHealth Care
10.2022 - 05.2023
Customer Service Advocate & Storefront Manager
Gi-Ro Dry Cleaner
08.2017 - 09.2019
UnitedHealth Group MyLearning
Medicare & Retirement Certification I, II, & III
Niagara University
Stock/Stock Option Certificate from Economics
Niagara University
Accounting Certificate from Accounting And Finance
Chelsea Gagliardi