Deja Shaw
Columbia,SC
Summary
A flexible individual who adapts seamlessly to the constant evolving work environment, providing outstanding customer service skills, problem solving and well organized with extensive knowledge in a variety of fields. Hoping to achieve and grow in a progressive organization with many opportunities to improve and grow. Authorized to work in the US for any employer.
Overview
9
9
years of professional experience
Work History
Provider Enrollment Analyst
Blue Cross & Blue Shield of SC - Contract Role
03.2024 - Current
- Provides quality service and communicates effectively with external/internal customers in response to inquiries (claims, correspondence, telephone).
- Assists Technical Support staff with testing system changes related to provider files.
- Obtains information from internal department, providers, government and/or private agencies, etc. to resolve discrepancies/problems.
- Performed all of the following in the enrollment of providers determines the acceptability of provider enrollment applications (which may be used for initial full application, re-enrollment, reactivation, deactivation, change of information).
- Provides in-depth review and verification/validation of provider data and verifies by use of information databases and various organizations/agencies to ensure authenticity; sets up/tests EFT accounts.
Titling & Licensing Specialist II
Department of Motor Vehicles
07.2023 - 03.2024
- Assisted with training new employees in the customer service department
- Answered incoming customer inquiries via phone and email
- Handled escalated calls from dissatisfied customers professionally and courteously
- Managed wide variety of customer service and administrative tasks to resolve customer issues
- Sorted and distributed incoming faxes, letters and emails for office distribution
- Help maintain customers account, financial responsibility and keep current
- Provided prompt, accurate, thorough and courteous responses to all complex inquiries from Medicare Advantage members and providers
- Displayed strong telephone etiquette, effectively handling difficult calls
- Ensures claims are processing according to established quality and production standards
- Thoroughly explained and resolved billing issues, took payments, set up drafting and sent invoices to clients
- Acted as intermediary between insurance companies and customers by researching and assessing information to determine claim validity
- Retained strong medical terminology understanding in effort to better comprehend procedures dealing with Medicare including (part A and B.) Examined/reviewed reports, accounts, and evidence to determine the information related to specific claims.
Senior Client Service Representative
Blue Cross & Blue Shield of SC - Contract Role
09.2022 - 05.2023
- Provided prompt, accurate, thorough and courteous responses to all complex inquiries from Medicare Advantage members and providers.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Ensures claims are processing according to established quality and production standards.
- Thoroughly explained and resolved billing issues, took payments, set up drafting and sent invoices to clients.
- Acted as intermediary between insurance companies and customers by researching and assessing information to determine claim validity.
- Retained strong medical terminology understanding in effort to better comprehend procedures dealing with Medicare including (part A and B.)
- Examined/reviewed reports, accounts, and evidence to determine the information related to specific claims.
Unemployment Claims CSR - contract role
Accenture
10.2021 - 03.2022
- Greet customers warmly and ascertain problems or reason for calling
- Communicated with people from various cultures and backgrounds on the application process
- Interviewed applicants and explained the scope of different available benefits
- Scheduled appointments with applicants to gather information and explain benefits processes
- Documented all communication with applicants and inputted information into the system
- Reviewed applications for different aid programs and determined which qualification criteria for individuals
- Meet personal/team targets and call handling quotas
- Manage large amounts of incoming calls.
- Investigated claims and prepared processing documentation.
- Liaised between patient, doctor and insurance provider to smooth claims processes.
Soldier
US ARMY
02.2016 - 11.2017
- Responsible for manual and computer records to perform stock control and accounting procedures for ammunition, and explosives/components
- Maintain an ammunition supply point and transfer ordnance from that supply point to the unit/to ensure the soldiers have what they need
- Perform the issue, receipt, shipment, turn-in and maintenance transfer of ammunition
- Providing logistical support in the brigade support battalion and ammunition supply point (ASP)
- Simplify and standardize maintenance data, and raise the quality and accuracy of performance, cost, and parts data through improved maintenance management
- Co-Manage and ensure the readiness of up to 10-15 personnel are in the correct place, at the scheduled time, in the correct uniform fit for the training event scheduled
- Occasionally lead training classes
- Ensure up to 5-10 vehicles and other equipment assets are maintained and combat ready through communication with maintenance department and proper maintenance scheduling.
Education
Diploma -
Richand Northeast High School
Columbia, SC06.2014
Skills
- Medicare and Medicaid knowledge
- Customer Service
- Data Analysis
- Multi-Phone Talent
- Military Experience
- 10- KEY
- Adaptability
- Interpersonal communication
- Computer literacy
Timeline
Provider Enrollment Analyst
Blue Cross & Blue Shield of SC - Contract Role
03.2024 - Current
Titling & Licensing Specialist II
Department of Motor Vehicles
07.2023 - 03.2024
Senior Client Service Representative
Blue Cross & Blue Shield of SC - Contract Role
09.2022 - 05.2023
Unemployment Claims CSR - contract role
Accenture
10.2021 - 03.2022
Soldier
US ARMY
02.2016 - 11.2017
Diploma -
Richand Northeast High School
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