Knowledgeable and dedicated customer service professional with over 18 years experience with strong skills in providing quality customer care. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with members and providers. Motivated to maintain customer satisfaction and contribute to company success. Articulate, energetic and results-oriented with exemplary passion for developing relationships and cultivating partnerships.
Hi, I’m
Dawn Mathews
Syracuse,NY
Summary
Overview
18
years of professional experience
Work History
EmblemHealth
Provider Contract Specialist
12.2021 - Current
Job overview
- Built and maintained relationships with new and existing clients while providing high level of expertise
- Monitored issues carefully and reached out to customers to provide immediate resolution and maintain satisfaction
- Worked with Credentialing and Claims departments to facilitate communication and deliver personalized solutions to customers
- Created plans and communicated deadlines to complete projects on time
- Resolved problems, improved operations and provided exceptional service
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
EmblemHealth
Customer Service Representative
08.2007 - 12.2021
Job overview
- Answered and recorded telephone/correspondence/email inquiries from subscribers, providers and other customers in relation to health insurance coverage.
- Provided customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Reviewed and resubmitted claims to be reprocessed to correct errors and maintain member and provider satisfaction.
- Partnered with Provider Contracting and Management team to field and resolve physician/ practice questions/issues regarding fee schedules, contracts and provider file updates.
Deluxe
Quality Assurance Associate
01.2005 - 12.2006
Job overview
- Monitored customer service associate calls for quality and provided feedback to team leaders regarding strength and development opportunities
- Provided documentation on trends to leadership team in relation to call quality, accuracy, sales and customer surveys for improvement and development
- Supported audit preparation through research, analysis and presentation development
- Provided regular updates to team leadership on quality metrics by communicating consistency problems and deficiencies
- Collaborated with management to provide training on improved processes and assisted with creation and maintenance of quality training
- Educated employees on specific QA standards and confirmed maintenance of standards
Education
Central City Business InstituteSyracuse, NY
Associate's Degree from Business Administration/Management
1993
University Overview
Skills
- Good listening skills
- Medical terminology knowledge
- Professional telephone demeanor
- Customer Complaint Resolution
- Insurance Specialist
- Quality Management
- Multitasking abilities
- MS Office/Excel/PowerPoint
- FACETS
- TruProvider
- SalesForce
- Customer Relationship Management
Timeline
Provider Contract Specialist
EmblemHealth
12.2021 - Current
Customer Service Representative
EmblemHealth
08.2007 - 12.2021
Quality Assurance Associate
Deluxe
01.2005 - 12.2006
Central City Business Institute
Associate's Degree from Business Administration/Management
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