Summary
Overview
Work History
Education
Skills
Timeline
BusinessAnalyst
David L. Fowler

David L. Fowler

Tucson,AZ

Summary

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
05.1998 - 07.2002

Auto Dealership Insurance & Licensing Cert. -

Pennsylvania Automotive Association

Certification For Emergency Medical Technician -

CCAC Dept of Public Safety

High School Diploma - Academic- General Studies

Woodland Hills High School
David L. Fowler