Deborah Horton
Citrus Heights,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
8
8
years of professional experience
1
1
Certification
Work History
Customer Care Representative
Blue Shield of CA
11.2021 - 04.2022
- 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.
- Assisted customers in navigating through website features and functions to locate desired information or products.
- Followed up on customer inquiries not immediately resolved by providing timely updates on the status of their requests.
- Utilized problem-solving techniques such as root cause analysis to identify recurring issues that could be addressed proactively.
- Escalated unresolved issues requiring further investigation or specialized expertise.
- Ensured compliance with company policies regarding privacy laws and data protection regulations.
- Maintained a detailed record of all customer interactions, transactions, comments, and complaints.
- Delivered customer support to high call load each shift.
- De-escalated customer issues with proven conflict mediation and problem-solving abilities.
- Interacted with customers to provide and process information in response to inquiries, concerns and requests about services and products.
Customer Service Rep
Gardner Insurance & Financial Services
10.2014 - 01.2020
- Performed administrative tasks such as filing paperwork, updating databases and generating reports.
- 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.
- 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.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Developed positive relationships with customers through friendly interactions.
Education
No Degree - Medical Billing And Coding
DeVry University
Villa Park, IL11.2023
Skills
- 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
- CCA Certified in Medical Coding and Billing
- Clerical Support
- Data Entry
- Customer Service
- Appointment Scheduling
- Payment Processing
- Problem Resolution
- Inbound Customer Service
- Administrative and Office Support
- Reliability
- Microsoft Office expertise
- Remote Office Availability
Certification
- CCA Certificate (4/2024)
- Personal Lines Insurance/Broker License in CA
References
References available upon request.
Timeline
Customer Care Representative
Blue Shield of CA
11.2021 - 04.2022
Customer Service Rep
Gardner Insurance & Financial Services
10.2014 - 01.2020
No Degree - Medical Billing And Coding
DeVry University