Cierra Grant
Richmond,VA
Summary
Knowledgeable and dedicated customer service professional with extensive experience in the medical industry seeking a Customer Service Representative position with CVS. Solid team player with an outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed, and process optimization. Articulate, energetic, and results-oriented with an exemplary passion for developing relationships, cultivating partnerships, and growing businesses.
Overview
11
11
years of professional experience
Work History
Sr. Eligibility Specialist Liaison Team Lead
Maximus
10.2018 - Current
- Thoroughly research each inquiry received and provide either resolution or timeframe in which member or provider can expect resolution based on level of effort required.
- Working on incoming Medicaid/Medicare cases via fax to process coverage requests from members or prescribers.
- Answer calls from patients, physicians, and authorized representatives, regarding benefits, patient bill balance, payment plans, payments, and general customer inquiries
- Work to ensure there is positive experience for customers by coaching other employees.
- Process Medicaid/Medicare insurance claims
- Ensure company goals and objectives are being met by each employee and provide constructive feedback.
- Understand plan policy and procedures.
- Process Medicaid/Medicare applications/claims for state of Virginia.
- Performs review of member claim history.
- Communicating with clients to verify personal information.
- Taking accountability to fully understand members’ needs by building trusting and caring relationships with members.
- Solving problems and dealing with multiple concrete variables in different situations.
- Follow HIPAA regulations
Customer Service Representative/Pharmacy Helpdesk
Express Scripts
05.2015 - 10.2018
- Handled inbound and outbound member, provider, pharmacist, and physicians’ calls.
- Answered questions related to pharmacist processing claims and members’ benefits, while maintaining productivity standards and performance guarantees where applicable.
- Provide prompt, accurate and courteous responses to member, provider, pharmacist and physicians.
- Worked with other operational departments to research and resolve mail orders and claims and respond to members within guidelines.
- Display active listening and excellent customer service skills.
- Assisted pharmacists, providers and members with getting paid claims.
- Maintained accurate and complete documentation of all inquiries to continuously improve customer service process and reduce legal concerns.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Other duties as assigned.
Customer Service Representative
General Dynamics
06.2012 - 05.2015
- Responding to numerous phone inquiries regarding Medicare Part A, B, C, and D, benefit plans, prescription plans, and provider information.
- Assist with enrollment.
- Ensuring all cases are properly closed.
- Researching and correcting any issues found in overall process.
- Working on incoming cases via fax to process coverage requests from members or prescribers.
- Using standard technology: telephones, e-mail, and web browsers.
- Assisting callers in finishing online applications.
- Maintaining up-to-date knowledge of regulations and policies as they apply to healthcare services we offer.
- Work closely with healthcare providers to process Organization exception requests in call center environment.
- Perform work in accordance with Medicare Part B guidelines.
- Completing all training as necessary.
- Determines medical necessity, and applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
Education
Medical - Assistance and Office Administration
FORTIS COLLEGE
08.2013
Skills
- Strong customer service skills
- Professionalism
- Carry out and prioritize multiple tasks
- Computer knowledge
- Ability to type 35–40 words per minute
- Active listening and excellent communication skills (written and verbal)
- Good organization skills
- Detail orientated
- Ability to quickly learn and navigate new systems
- Adaptable to change
- Medical Terminology
Timeline
Sr. Eligibility Specialist Liaison Team Lead
Maximus
10.2018 - Current
Customer Service Representative/Pharmacy Helpdesk
Express Scripts
05.2015 - 10.2018
Customer Service Representative
General Dynamics
06.2012 - 05.2015
Medical - Assistance and Office Administration
FORTIS COLLEGE
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