A position in a results-oriented company that seeks an ambitious and career conscious person, where acquired skills and education will be utilized toward growth and advancement. 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
25
25
years of professional experience
Work History
Provider Support Representative
Aston Carter
01.2023 - 02.2023
Responds to inbound calls regarding claims submitted for medical health care, provider status and availability, or claims payment and status
Accurately assesses caller requests, answers caller inquires and processes requests while focusing on first call resolution and/or appropriate call escalation protocols
Initiates and receives phone calls from VA medical center staff, and providers to answer claims, eligibility, benefit and program questions
Records preferences, tracks Provider's questions thoroughly in the TriWest’s Customer Relationship Management systems and Portal
Takes appropriate measures to comply with HIPAA regulations to protect privacy of customers' health information
Protects the privacy of health information of patients when using or disclosing Protected Health Information (PHI)
Caregiver
Instant Care of Arizona, Duties include but not limited
05.2019 - 10.2022
Appointment reminders
Bathing assistance
Companion services
Meal preparation
Light housekeeping
Medication assistance Physical therapy
Speech therapy
Transportation(Dr's Appts, shopping, etc.)
Customer Care Representative
Elixir Solutions Inc
11.2020 - 09.2022
Answer incoming calls from Members on issues related to benefit eligibility questions for their Pharmacy Benefits provider by Commercial, Medicaid, Medicare, or Discount Drug plans
Help guide and educate customers on their prescription benefits, use of plan, formulary, premiums and status of orders, and claims or inquiries
Ask appropriate questions and listen actively to identify any questions or issues while documenting required information in computer systems
Identify issues and communicate solutions and steps to customers, pharmacies, and physicians with prescription orders and reorders
Escalate drug related calls as appropriate to licensed pharmacist for resolution
Coordinate internal resolution of claims exceptions and other issues to include determining appropriateness of overriding pharmacy claims edits and error messages
Make outbound calls to customers on prescriptions withhold orders and payment issue
Collections Specialist 3
Citibank Cards Division, Duties include but not limited
10.2019 - 10.2020
Uses advanced negotiation skills to resolve escalated calls
Coaches trains lower level Collectors and new team members
Prioritizes workflow to help identify process improvements
Interprets procedures instructions by choosing among alternatives to resolve problems
Works under limited supervision
May support an expansive array of products services
Demonstrates technical administrative expertise
Applies specialized functional area skills and basic knowledge including underlying professional technical principles or standards, which are well defined
Understands how duties relate with others in the team/unit and how the unit integrates with others in accomplishing the work of the function
Appropriately assess risk when business decisions are made, demonstrating particular consideration for the firm's reputation and safeguarding Citigroup, its clients and assets, by driving compliance with applicable laws, rules and regulations, adhering to Policy, applying sound ethical judgment regarding personal behavior, conduct and business practices, and escalating, managing and reporting control issues with transparency.
Lead Claims Analyst
Centene Corp
02.2018 - 08.2019
Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues
Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims
Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis
Assist in creating work flows for the department and support team members in understanding changes in work processes
Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues
Assists supervisor to research and determine the status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions
Maintains records and reports as assigned
Assist in meeting departmental production and quality standards
Running and analyzing of Unpaid Claims Report for Line Of Business assigned to for problems and corrections to make system process to a payable status
Process Claims as needed
WFM - Set and adjusted to schedules to maintain optimal coverage and service levels.
Caregiver
Dependable Nurses Inc, Duties include but not limited
04.2011 - 05.2019
Appointment reminders
Bathing assistance
Companion services
Meal preparation
Light housekeeping
Medication assistance Physical therapy
Speech therapy
Transportation(Dr's Appts, shopping, etc.)
Claims Analyst
Centene Corp
07.2017 - 01.2018
Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility
Ensure payments and/or denials are made in accordance with company practices and procedures
Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied
Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims
Research and determine status of medical related claims
Review charges, access the computer system and use payment or denial codes within established department guidelines and standards
Clarify health insurance coverage for coordination of benefits to process claims
Maintain records, files, and documentation as appropriate
Meet department production and quality standards
Universal Customer Account Executive
Comcast Corp
02.2016 - 01.2017
Provide end-to-end support for customers/communities in a way that is in accordance with the Company's service delivery strategy
Establish rapport and promotes effective relationships, upholding commitment to the customer experience through Operating Principles, Voice of the Customer (VOC) surveys, and the Comcast Customer Guarantee
Responsible for accurately and confidently handling customer inquiries including billing and technical questions
Responsible for handling escalated cancellation requests from customers and responsible for solving all issues, taking a consultative approach to finding custom solutions to customers' needs, as well as handling potential sales opportunities
Resolve problems related to Comcast products as well ascustomer equipment
Promote company products and services and makes recommendations that meet the customer needs
Relate well to the customer, demonstrate favorable image of organization through effective use of soft skills and problem solving skills, professional communications and internal/external customer interactions
Exercise sound judgment within the scope of empowerment, and acts in the best interest of both the customer and company.
Customer Service Advocate
OptumRx
09.2012 - 10.2015
Answer incoming calls from our customers on issues related to benefit eligibility questions and prescription order inquiries
Help guide and educate customers on their prescription benefits, use of plan, formulary, premiums and status of orders, and claims or inquiries
Ask appropriate questions and listen actively to identify any questions or issues while documenting required information in computer systems
Identify issues and communicate solutions and steps to customers, pharmacies, and physicians with prescription orders and reorders
Escalate drug related calls as appropriate to licensed pharmacist for resolution
Coordinate internal resolution of claims exceptions and other issues to include determining appropriateness of overriding pharmacy claims edits and error messages
Make outbound calls to customers on prescriptions withhold orders and payment issue
May also assist with entering new prescription orders into system
Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
Certified as a Presenter of Exceptional Training (POET) in which I regularly facilitated classes for system updates and processes & assisted Trainers with New Hire classes
Lead a team of several agents for the overseeing of agents at our outsourced offices
Monitored calls and provided “Real Time feedback of calls taken
Involved in numerous test teams to develop processes and updates to systems used daily by agents
Customer Sales Consultant
Afni Inc, Duties included but not limited
03.2009 - 03.2011
Answer customer inquiries, and resolve problems
Identify customer needs and promote and sell products/services
Notate customer account in a professional manner and enter and confirm sales
Attend training to update product/service knowledge
Recommend new ideas and procedures to improve efficiency and effectiveness
Build and maintain rapport with the customer
Utilize Afni and client reference information and computer software to investigate and update activity on customer account.
Internet Sales Manager/Sales Consultant
Hamilton Mazda, Duties included but not limited
08.2007 - 08.2008
Responding to incoming email from potential customers in a timely manner keeping compliance with both brands sold
Assessing the needs of the customer through email and phone contact to find the vehicle best suited for their needs
Provide quotes for potential purchases along with payments and finance options
Continued follow-up of both sold and unsold customers
Extensive knowledge of Mazda & Subaru product and its competitors
Maintain and update the dealerships several websites with both used inventory, specials, and monthly programs from the manufacturer
Thorough knowledge of Microsoft Office and its applications.
Sales and Leasing Consultant/ F&I Mgr
Tri Star Ford, Duties included but not limited
06.2004 - 04.2007
(Sales) Meeting and greeting potential customer assessing their needs in a vehicle, and presenting them with possible choices to purchase
Continued follow-up of both sold and unsold customers
Extensive knowledge of Ford product and its competitors
(F&I) Submission of applications received for financing of prospective customers to both conventional and secondary lenders as guidelines allowed
Communicating with representatives of those banks in order to secure financing
Extensive paperwork and computer use required
Knowledge of ADP.
Assistant Operations Manager/Armed Guard
Capital Asset Protection Inc, Responsibilities included but not limited
05.1998 - 07.2002
To recruit screen and interview potential employees for positions available at both of our PA offices; conferring with management and other supervisors to identify personnel needs, job specifications, job duties, qualifications and skills; developing and maintaining a network of contacts to help identify and source qualified candidates; and reviewing applications and interviewing applicants to obtain work history, education, job skills and salary requirements, and to provide information about the company and the position(s) available
Weekly scheduling of 62 officers; Bi-weekly calculating and submission of hours work for officers worked to payroll; Preparation and submission of proposals for potential clients outlining our services and capabilities
Supervision and discipline of employees, ranging from site checks, monthly evaluations, and any disciplinary write-ups or other disciplinary actions required; Client contact: communicating with the client and dealing with any problems or concerns brought out by the client until solved to their satisfaction; Safety patrols: looking for any possible hazards, problems, or tampering of property assigned to secure
Organization of strike details for lockouts and work stoppages along with executive protection details or body guarding.
Education
Auto Dealership Insurance & Licensing Cert. -
Pennsylvania Automotive Association
2006
Certification For Emergency Medical Technician -
CCAC Dept of Public Safety
1997
High School Diploma - Academic- General Studies
Woodland Hills High School
Pittsburgh, PA
06.1992
Skills
Error-Detection
Time Management
JavaScript
PERL
Team Support
Speaking
Organizational Skills
Complex Problem-Solving
Staff Support
Individual Support
Client Support
Customer Needs Assessments
Train Employees
Customer Relationship Management
Active Listening
Instructing
Judgment and Decision-Making
Timeline
Provider Support Representative
Aston Carter
01.2023 - 02.2023
Customer Care Representative
Elixir Solutions Inc
11.2020 - 09.2022
Collections Specialist 3
Citibank Cards Division, Duties include but not limited
10.2019 - 10.2020
Caregiver
Instant Care of Arizona, Duties include but not limited
05.2019 - 10.2022
Lead Claims Analyst
Centene Corp
02.2018 - 08.2019
Claims Analyst
Centene Corp
07.2017 - 01.2018
Universal Customer Account Executive
Comcast Corp
02.2016 - 01.2017
Customer Service Advocate
OptumRx
09.2012 - 10.2015
Caregiver
Dependable Nurses Inc, Duties include but not limited
04.2011 - 05.2019
Customer Sales Consultant
Afni Inc, Duties included but not limited
03.2009 - 03.2011
Internet Sales Manager/Sales Consultant
Hamilton Mazda, Duties included but not limited
08.2007 - 08.2008
Sales and Leasing Consultant/ F&I Mgr
Tri Star Ford, Duties included but not limited
06.2004 - 04.2007
Assistant Operations Manager/Armed Guard
Capital Asset Protection Inc, Responsibilities included but not limited