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.
Hi, I’m
Chelsea Gagliardi
Summary
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
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