Deborah Horton
Citrus Heights, Roseville,CA
Summary
Knowledgeable and dedicated customer service professional with extensive experience in health insurance industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with members. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses. Knowledge of researching and relaying diagnosis codes in order to provide member with accuracy of coverage and cost based on plan guidelines. Ability to read policy plans and advise members of coverage provided by plan type.
Overview
9
9
years of professional experience
Work History
Customer Care Representative
Blue Shield of CA
11.2021 - Current
- Answered members eligibility and benefit inquiries
- Assisted members with updating primary care physicians
- Assisted members with prescription drug inquiries and claims
- Explained deductible, co-payments and policy benefits to members
- Assisted members with filing grievances and appeals in regard to benefit dissatisfaction
- Answered member inquiries in regard to their prior authorization requests
- Assisted members with updating personal account information such as address and email updates
- Assisted members with registering for online portals
- Educated members on how to locate facilities and physicians within their plan network
- Priced allowed amounts for member procedures to determine out of pocket costs
- Worked with medical groups and pharmacies to ensure member needs were addressed
Customer Service Rep
Gardner Insurance & Financial Services
10.2014 - 01.2020
- Performed support duties such as answering phones, scheduling meetings, processing mail, filing documents, noting client accounts each time contact is made
- First line of contact between clients and agents
- Directed calls to appropriate management and staff members
- Addressed customer concerns and questions regarding their policy &/or billing accounts verbally and in writing
- Has a general understanding of policy contracts and can explain policy details to clients both verbally and in writing
- Prepares files and documents needed for agent/client meetings
- Processes customer payments and maintain deposits and account receivable for the agency
- Ensures contract requirements and appropriate forms are fulfilled by deadlines
- Assists clients with claims administration process
- Responsible for ensuring client’s profiles were up to date with the most current personal information
- Worked in conjunction with outside entities such as loan, mortgagee, and title officers to ensure clients home loans went through without a hitch
- Worked with Policy Underwriters regarding policies issuance, concerns, and/or discrepancies including, but not limited to, providing necessary documentation and information to issue a policy, as well handling any policy issuance disputes
- Worked with Claims Representatives in many capacities including, but not limited to, providing client information needed to file a claim, providing claim details, and ensuring claim was handled quickly and effectively
Education
No Degree - Medical Billing And Coding
DeVry University
Villa Park, IL11.2023
Skills
- Computer Software Knowledge Internet
- Explorer, Microsoft Word, Outlook, Excel
- Qualifications
- Excellent customer service experience in a fast-paced insurance agency
- Able to quickly adapt to new system platforms
- Works well independently and as a team member
- Strong research ability, record management and organizational skills
- Extremely reliable and detail oriented
- Possesses a personal lines property/casualty broker/agent license in the state of California
- Problem Resolution
- Clerical Support
Timeline
Customer Care Representative
Blue Shield of CA
11.2021 - Current
Customer Service Rep
Gardner Insurance & Financial Services
10.2014 - 01.2020
No Degree - Medical Billing And Coding
DeVry University