Diamond Moore

• Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
• Developed strong relationships with clients by providing empathetic support and understanding during challenging health situations.
• Investigated insurance claims denials and appeals.
• Educated customers about billing, payment processing and support policies and procedures.
• Partnered with other departments to ensure customer needs are met.
• Provided benefit information, educated clients on claim denials and approvals and explaining plan eligibility.
• Managed high-volume call center, ensuring prompt and accurate responses to all inquiries related to health benefits.
• Conducted thorough investigations into disputed claims, resulting in fair resolutions for both parties involved.
• Answered questions about eligibility determinations and plan options.

• Assisted customers in navigating company website and placing online orders, improving overall user experience.
• Contributed to sales growth by upselling products and services based on individual customer requirements.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Responded to customer requests for products, services, and company information.
• Participated in team meetings and training sessions to stay informed about product updates and changes.
• Investigated and resolved accounting, service and delivery concerns.
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• Consistently met or exceeded performance targets through diligent attention to detail and strong communication skills.
• Boosted client retention rates by providing exceptional customer service and building rapport with callers.
• Analyzed and escalated complaints, issues and grievances to designated departments for investigation and response.

Reviews and researches billing and healthcare claim inquiries from members and providers, to ensure

proper benefits and/or payments are applied correctly; researches multiple computer systems/applications

to verify data/information accuracy.

• Responds to inquiries regarding adjustments, refunds, edits and/or payment registers to ensure

completeness, accuracy and customer satisfaction to members or providers.

• Maintains knowledge of required lines of business, changes to applicable company policies/procedures,

recent laws and regulations, and related computer systems to ensure information is current and accurate

when providing service to members or providers on the telephone in the call center.

• Meet Customer Service performance goals/expectations in the areas of efficiency, accuracy, quality,

production, customer satisfaction, and attendance

• The ability to verbally communicate on the telephone approximately 95% of the time.

• Perform other job-related duties as assigned, within your scope of responsibilities.