Dawn Riley
CVS Aetna
Lancaster,USA
13
years of professional experience
Experienced with handling patient inquiries and providing support in healthcare setting. Utilizes strong communication skills and empathy to resolve issues and ensure patient satisfaction. Knowledge of healthcare protocols and procedures, contributing to efficient and effective service delivery.
Work History
Healthcare Customer Service Representative
11 Months- Assist members with claims processing.
- Communicate with provider to resolve inquiries.
- Complete claim submissions accurately and efficiently.
- Utilize daily systems including MedCompass, Makensee, GPS (Salesforce), AEPpass, AST/CXT, ClaimsXten (CXT), TPS, CPB, STARS, and Prospective Claim Accuracy (PCA).
- Apply medical terminology, ACAS coverage codes, CPT-10 codes, and HCPC updates for claims and COBS. Met established performance metrics.
- Remote
- Resolved complex client issues by utilizing conflict resolution and negotiation skills effectively.
Payment Specialist
6 Years 11 Months- Review, analyze and prepare payments for accuracy and completeness prior to processing.
- Monitor daily payment activity in order to identify any discrepancies or errors.
- Process payments using various methods such as ACH, Debit, and Credit Card.
- Set-up payment arrangements.
- Research customer accounts to ensure that all payments were properly applied and reconciled.
- Assist customers with inquiries regarding their payment status or account balances.
- Use salesforce to lookup customers information and orders to check for accuracy.
- Investigate customer complaints related to incorrect payments or billing disputes.
- Processed high-volume payment transactions efficiently, ensuring accuracy and compliance with company standards.
Administrative Support Specialist
4 Years 4 Months- Responsible for submitting and processing Web, & Siebel orders.
- Confident in using the CSSR and COPP as resources to help with questions on procedures.
- Calling customers in regards to their phone and internet orders.
- Proficient in DESI/SABRE, Martens, INAT, Siebel, RMS, Adobe Standard & Microsoft Office 10.
- Implemented data entry procedures that increased accuracy and reduced processing errors across departments.
Education
Technical Diploma
GPA: 3.87
Skills
Problem-Solving
Interpersonal Skills
Customer Service
Evicore
ECHS
COB OBD tool
AST/CXT inquiry
Agent tool
GPS
Microsoft Excel & Office
Zendesk
Proficient in salesforce
Problem-Solving
LEADERSHIP EXPERIENCE
- 8 Moms with a Cause Organization
- Co-Chair & Fundraising Events for the epilepsy foundation of Southern Wisconsin.
Timeline
Healthcare Customer Service Representative
CVS Aetna
09.2025 - CurrentRead More
Payment Specialist
SC Contact Center
10.2018 - 09.2025Read More
Administrative Support Specialist
TDS Telecom
10.2013 - 02.2018Read More
Southwest Technical College
Technical Diploma
Read More