Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
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Edqueisha Edwards

Tampa

Summary

Dedicated Customer Service Representative with extensive experience in resolving customer and claims inquiries across the healthcare and customer service sectors. Proven track record at McDonalds , Anthem, and Aetna in enhancing customer satisfaction and loyalty through empathetic problem-solving and efficient resolution of complex issues. Successfully trained new representatives, streamlined claims processes, and improved service quality. Demonstrates strong analytical skills, adaptability, and the ability to meet key performance indicators, contributing to overall team success and customer retention. Proficient in handling member inquiries, processing payments, and providing detailed product information to ensure a positive customer experience.

Overview

8
8
years of professional experience

Work History

Shift Manager

McDonalds
09.2016 - Current
  • Handled escalated customer issues effectively, demonstrating strong problem-solving skills while upholding company values and standards.
  • Trained new employees on company policies, procedures, and job responsibilities, ensuring seamless integration into the team.
  • Improved overall team performance by effectively delegating tasks and providing clear instructions.
  • Collaborated with other Shift Managers to maintain consistency in policies enforcement across all shifts, fostering a cohesive workplace culture.
  • Cooperated with coworkers to improve customer experience and manage storefront.

Claims Customer Service Rep.

Anthem
12.2021 - 01.2024
  • Delivered training to new customer service representatives, focusing on efficient inquiry response and problem resolution
  • Efficiently resolve claims inquiries, boosting satisfaction and retention through effective solutions
  • Address complex claims with empathy, achieving high satisfaction and customer loyalty
  • Collaborate with team to streamline claims processes, reducing handling time and enhancing service
  • Utilize analytical skills to resolve claims issues, leading to measurable improvements in satisfaction
  • Support team efforts to improve claims processing efficiency, resulting in better service quality

Member Services

Aetna
11.2018 - 11.2021
  • Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
  • Verifies detailed insurance benefits, medical necessity, and authorization/referral guidelines, consistently prioritizing and following the established verification processes.
  • Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns
  • Resolve member complaints and inquiries in a courteous and professional manner
  • Accepted and processed members annual, semi-annual, and monthly payments
  • Performs all other duties, as assigned or requested, while adhering to strict deadlines.

Education

King High School -

King High School
Tampa, FL

Skills

  • Microsoft Office (Word, Excel, PowerPoint, Outlook)
  • Customer Service
  • Transaction Handling
  • Complaint Resolution
  • Client Relationship Management
  • Inquiry Resolution
  • Office Skills (Filing, Faxing, Photocopying, Typing)
  • Claims Processes
  • Applicant Qualification
  • Client Communication

Accomplishments

  • Dedicated Customer Service Representative with extensive experience in resolving customer and claims inquiries across the healthcare and customer service sectors.
  • Proven track record at Alorica, Anthem, and Aetna in enhancing customer satisfaction and loyalty through empathetic problem-solving and efficient resolution of complex issues.
  • Successfully trained new representatives, streamlined claims processes, and improved service quality.

Timeline

Claims Customer Service Rep.

Anthem
12.2021 - 01.2024

Member Services

Aetna
11.2018 - 11.2021

Shift Manager

McDonalds
09.2016 - Current

King High School -

King High School

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Edqueisha Edwards