Summary
Overview
Work History
Education
Skills
Timeline
BusinessAnalyst

COURTNEY SMITH

Covington,GA

Summary

Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires and providing customized solutions to build loyalty.

Overview

11
11
years of professional experience

Work History

Claims Specialist

TTEC/BCBS
01.2022 - 01.2023
  • Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
  • Followed up with customers on unresolved issues.
  • Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
  • Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
  • Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
  • Notified insurance agents and accounting departments of policy cancellations and changes.

Customer Service Representative

TTEC/BCBS
11.2021 - 01.2022
  • Demonstrate superior customer service and professionalism at all times
  • Answer incoming calls, respond to inquiries and route to the appropriate departments as needed.
  • Verified insurance eligibility and coverage for patients.
  • Filed and maintained patient records in accordance with HIPAA regulations.
  • Entered patient demographic and insurance data into electronic medical record system.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
  • Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Investigated and resolved customer inquiries and complaints quickly.
  • Educated clients on insurance policies and procedures.
  • Analyzed customer needs to provide customized insurance solutions.
  • Understood and thoroughly explained services provided to customers and potential customers.
  • Finalized and processed enrollment applications.

Material Operator

Medical Technologies Of Georgia
07.2019 - 10.2021
  • Used hand-held scanners and physical logs to accurately track item movements.
  • Operated forklifts and pallet jacks to transfer large products from one area of warehouse to another, allowing for easier accessibility.
  • Transported inventory items to appropriate locations.
  • Kept storage areas organized, clean, and secure to fully protect company assets.
  • Listened closely during team meetings to gain complete understanding of duties required for each shift, completing priority tasks first.
  • Packed items into appropriate containers for shipment.
  • Read production orders, work orders, shipping orders and requisitions to determine items to be moved, gathered, or distributed.

Administrative Coordinator

United Healthcare
11.2018 - 01.2019
  • Served as primary point of contact for providers/members regarding medical/behavioral/clinical services or benefits
  • Quality checked all documentation for accuracy and data integrity
  • Arranged placement of patients in facilities appropriate for level of care requirements.
  • Worked collaboratively with clinical and non-clinical team members to solve complex discharge issues.
  • Coordinated transfer of out-of-area patients into in-network facilities.
  • Identified and referred patients to social work department for additional coverage and services.
  • Solved problems related to abrupt changes in discharge, coordinated updates and communicated discharge plans.
  • Worked with utilization review to establish prior authorization for timely discharges.

Clinical Administrative Coordinator

United Healthcare, UHG
03.2015 - 11.2018
  • Answered incoming calls directed to appropriate areas or take messages and relay them to the appropriate staff member as necessary
  • Maintained provider appointment scheduling system including any cancellations and rescheduling that should occur, as directed by team leader, office manager or clinic administrator
  • Provided status updates on current patients with their clinicians in order to assist in best patient care, assists in the delivery and retrieval of physician paperwork and patient orders
  • Created, composed and maintained appeal response templates.
  • Verified client information by analyzing existing evidence on file.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Developed appeals functions, policies and procedures and documentation.
  • Reviewed cases to determine need for escalation.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Provided outreach for additional information for appeals and grievances.
  • Used critical thinking to break down problems, evaluate solutions and make decisions.

Picker & Packer

Macys Logistics
11.2011 - 02.2012
  • Responsible for, and releasing orders, ensuring order accuracy
  • Stacking production from a pallet and separating orders to stack neatly via warehouse assigned shelf
  • Inspected product for leaks and package defects, plus follow all appropriate safety, environmental protection, and/or policies and procedures in the transport of materials
  • Loaded and unloaded all trucks using various forklifts and hand trucks
  • Staged and organized all incoming and outgoing product
  • Assembled all documentation and overseeing functions of vehicles such as condition of equipment, loading and unloading, pre-trip inspection, verifying safety and security of cargo.
  • Worked fast to meet assigned daily picking quotas.
  • Pulled orders quickly to maintain demanding productivity goals.
  • Scanned and verified UPC codes for all products to aid in identification.
  • Replenished items taken from shelves, safely using equipment to lift and organize products.
  • Picked and packed order items.
  • Stocked shelves, racks and cases with new or transferred merchandise.

Education

Associates Degree - Criminal Justice

Strayer University

Skills

  • Medical Office Management Customer Service Support Quality Assurance Management
  • Exceptional Telephone Etiquette Data Entry Confidential Correspondence Critical Thinker
  • Reports/Documentation Result Execution Client Relations Communication Skills Attention to Detail
  • Problem Solving Medical Terminology Conflict Resolution Time Management Process Improvement
  • Database Management Microsoft Office Data Integrity Documentation & Control Strategic Planning
  • Business Development Understanding
  • Active Listening
  • Customer Relations
  • Credit Card Payment Processing
  • Sales Expertise
  • Microsoft Word
  • Microsoft PowerPoint
  • Administrative Support
  • CRM Software
  • POS Systems Expertise
  • Document Control

Timeline

Claims Specialist

TTEC/BCBS
01.2022 - 01.2023

Customer Service Representative

TTEC/BCBS
11.2021 - 01.2022

Material Operator

Medical Technologies Of Georgia
07.2019 - 10.2021

Administrative Coordinator

United Healthcare
11.2018 - 01.2019

Clinical Administrative Coordinator

United Healthcare, UHG
03.2015 - 11.2018

Picker & Packer

Macys Logistics
11.2011 - 02.2012

Associates Degree - Criminal Justice

Strayer University

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