Chris Ngoyi
Grosse Pointe Woods ,MI
Overview
13
13
years of professional experience
Work History
Post Service Appeals Coordinator
Apex Health
05.2023 - 12.2023
- Conducting investigations and reviewing customer appeals related to service provision and benefit coverage issues
- Initiating contact with customers to gather pertinent information and communicate the case's disposition; meticulously documenting all interactions
- Crafting written correspondence tailored to customers, including members, providers, and regulatory agencies
- Delving into administrative or non-clinical aspects of appeals, such as eligibility, benefit levels, and overall compliance with policies and practices
- Exercising discretion in rendering decisions on administrative appeals based on well-documented guidelines.
Compiling files for thorough internal or external review by analysts, medical staff, or external consultants - Prioritizing and categorizing clinical and non-clinical inquiries, grievances, and appeals, and meticulously preparing case files for member grievance committees/hearings
- Summarizing and delivering essential information to clinical specialists, medical directors, and legal counsel
- Generating and analyzing system reports to discern emerging trends and offer recommendations for resolution
- Orchestrating communication and training initiatives related to complaint and appeals management
Customer Service Representative
Apex Health
11.2022 - 05.2023
- Respond to inbound call center inquiries regarding insurance policies, coverage issues, consumer complaints, and general questions
- Ensure precision in processing client policy adjustments according to provided data
- Validate coverage for new customers and furnish policyholders with documentation proving insurance coverage
- Maintain records of all customer inquiries and conduct follow-ups to ensure comprehensive resolution of policy-related queries
- Stay informed about new marketing initiatives to effectively address inquiries about insurance products, leveraging available resources
- Address complaints, propose suitable resolutions and alternatives within specified timeframes, and conduct follow-ups to confirm issue resolution
General Manger
Black Cat Bistro
06.2014 - 05.2022
- Oversaw both back and front of house operations, ensuring adherence to service standards and optimizing staff efficiency
- Managed monthly financial statements, daily cash flow, payroll, and monthly reconciliation of general ledger accounts
- Proactively managed guest complaints in person, via email, and phone, ensuring swift resolution and facilitating constructive feedback for staff
- Instituted training initiatives to maintain staff compliance with regulations, overseeing inventory management and procurement processes
- Contributed actively to the Responsible Hospitality Council
Inside Sales Representative
Fastenal
06.2011 - 05.2013
- Proactively generated sales leads and nurtured ongoing customer relationships within an established accounts
- Handling incoming calls and emails from a designated Book of Business to promptly address concerns and disseminate vital company updates
- Orchestrated inventory management and inter-branch communications, liaising effectively with corporate headquarters
- Effectively communicating key business statistics and tracking progress towards predefined goals
- Demonstrating unwavering motivation and a steadfast commitment to achieving superior sales outcomes on a daily basis
Education
Bachelor of Arts - Communication
Michigan State University
East Lansing, MISkills
- Customer Relationship Management
- Call Center Operations
- Conflict Resolution
- Leadership
- Policy Interpretation
- Time Management
Timeline
Post Service Appeals Coordinator
Apex Health
05.2023 - 12.2023
Customer Service Representative
Apex Health
11.2022 - 05.2023
General Manger
Black Cat Bistro
06.2014 - 05.2022
Inside Sales Representative
Fastenal
06.2011 - 05.2013
Bachelor of Arts - Communication
Michigan State University
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