Dawn Seed
Charlotte,NC
Summary
Collaborative, Self-motivated and Multitasking Benefits Specialist demonstrating superior understanding of employee benefits while providing exemplary service regarding benefits support in fast-paced corporate settings.
Overview
6
6
years of professional experience
Work History
TPA Benefit Member Advocate
Premier Inc
01.2022 - Current
- Provide excellent customer service by responding to customer interactions via telephone, email, or internet, in professional, courteous, accurate manner while recording brief overview of communication.
- Resolves customer inquiries and concerns with first call resolution; assist with members needs regarding benefits, eligibility, claims, financial spending accounts and correspondence.
- Answers customer's questions to help guide and educate them through selecting best benefit plan options, maximize value of their health plan benefits by helping them understand and select quality care providers.
- Intervene with care providers (doctor's offices) on behalf of member to assist with appointment scheduling or connections with internal specialists for assistance.
- Provided resources in negotiating fees with healthcare providers on behalf of members.
- Encourages self-sufficiency by assisting members in navigating company websites, cell phone applications, and tools.
- Take ownership of each call to build rapport by providing resolutions on behalf of member in real time.
- Creates, generates, and initiates requests for customer callbacks to allow research and follow-up with customer.
- Research complex claims issues across multiple databases and work with support resources to resolve customer issues in addition to collaborating with other departments to resolve escalated issues.
- Provide benefits education and status on previously submitted pre-authorizations or pre-determination requests.
- Exceeds performance goals established for position in areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance.
- Participates in and supports development and implementation of special projects.
- Research and solve claims and billing issues.
- Helps members with eligibility and benefits coverage questions.
- Interfaces with insurance carriers, physicians, hospitals and other healthcare providers.
Benefits Customer Service Representative
Centene Corporation
03.2021 - 01.2022
- Handled high volume inbound calls from Medicaid Members and Healthcare Providers benefits, eligibility and claims inquires.
- Provide excellent customer service by responding to customer interactions via telephone, email, or internet, in professional, courteous, accurate manner while recording brief overview of communication.
- Contracted/temporary assignment assisting customers with enrolling for online benefits programs, resetting user names and passwords.
- Responsible for updating accounts with correct information for proper reception with advanced access codes for financial transfers and bill pay.
- Assisted assist customers with accessing their accounts due to customer account protection blocks that prevent fraud and offer advanced protection.
Small Business Sales Representative
Spectrum Business
07.2020 - 03.2021
- Provided excellent customer service by responding to customer interactions via telephone, email, internet, or in person in professional, courteous, accurate manner while recording brief overview of communication.
- Acquired and demonstrated thorough knowledge of competitors’ pricing, packaging, and products in effort to discuss side by side comparisons of Spectrum’s and competitors’ products and services.
- Successfully sold over thirty thousand dollars in first six months of business.
- Ability to learn and master order processing within billing system regarding all aspects of retained accounts, new sales order entry, account lookup, and other tools and functions as they relate to retention function.
- Successfully conducted both cold and warm sales calls.
- Duties also included office management, customer support for online order status, history.
- Logged, tracked and managed leads, contacts, organizations, partners, vendors and suppliers.
- Effectively used consulting, coaching, customer service, inside sales and aggressive phone skills to maximize revenues.
- Strategically utilized reports to meet performance expectations achieve goals and hit sales quotas.
- Resolved customer issues and escalations.
- Successfully retained existing clients by providing excellent service, anticipating their future requirements, and presenting appropriate solutions
Benefits Verification Specialist
TalentBridge, Lash Group
10.2019 - 02.2020
- Collected and reviewed all patient insurance information needed to complete benefit verification process
- Verified patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options according to Program specific SOPs.
- Identified any restrictions and details on how to expedite patient access.
- Received call transfers from intake representatives to verify information with potential clients.
- · Documented, initiated prior authorization process and claims appeals.
- Made follow up calls for missing items or document retrieval.
- Completed quality review of work as part of finalizing product.
- Performed related duties and special projects as assigned.
Rental Consultant
Cort
04.2018 - 04.2019
- Performed data entry of customers orders into salesforce system and scheduled order delivery to customers.
- Evaluated needs in order to advise customers on benefits of previously rented furniture in order to maximize revenue opportunities.
- Provide excellent customer service by responding to customer interactions via telephone, email, or internet, in professional, courteous, accurate manner while recording brief overview of communication.
- Sold and closed territory specific deals which included Inputting leases and completed inventory support tasks.
- Obtained credit information required to facilitate approvals for customers.
- Created detailed quote preparation and support for outside sales force.
- Forwarded forms to credit office for verification of customer credit status and approval of order.
- Rented items, arranged for provision of services to customers, and accept returns.
Education
Master of Arts - Sociology
Loyola University of Chicago
Chicago, IL05.2000
Bachelor of Arts - Sociology
Loyola University of Chicago
Chicago, IL05.1998
Skills
Technical Skills
- Medicaid Experience
- Data Entry
- Phone Etiquette
- Scheduling
- MS Word, MS Excel, MS PowerPoint, MS Office Publisher
- Medical Benefits Servicing Systems: Healthpac, HealthX, Salesforce
Industry Knowledge
- HIPAA Compliance
- Technical Support
- Route Dispatch
- Customer Service Management
- Medical Terminology Knowledge
Skills
- Communication Skills, written and oral
- Active Listening Skills
- Data Entry
- Consulting
- Customer Service, customer support, telephone
- Data entry: MS Excel, MS Office, Outlook, MS PowerPoint, Publisher, MS Word, Salesforce
- Policy Interpretation
- Documentation and reporting
- Problem Solving Abilities
- Attention to Details
- Office management: selling, sales, scheduling, phone skills, trade shows, type, video, websites
Timeline
TPA Benefit Member Advocate
Premier Inc
01.2022 - Current
Benefits Customer Service Representative
Centene Corporation
03.2021 - 01.2022
Small Business Sales Representative
Spectrum Business
07.2020 - 03.2021
Benefits Verification Specialist
TalentBridge, Lash Group
10.2019 - 02.2020
Rental Consultant
Cort
04.2018 - 04.2019
Master of Arts - Sociology
Loyola University of Chicago
Bachelor of Arts - Sociology
Loyola University of Chicago
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