Erick Alexander
Jacksonville,FL
Summary
To secure a challenging position in a reputable organization to expand learnings, knowledge, and skills.
Overview
15
15
years of professional experience
Work History
Member/Provider Service Representative
Value Health Benefit Management LLC
07.2023 - 08.2024
- Helped large volume of members/medical providers every day per Inbound/Outbound calls with positive attitude and focus on member/provider satisfaction.
- Responded to members/medical providers concerns with friendly and knowledgeable service and remedied issues promptly and effectively.
- Maintained members/medical providers satisfaction with forward-thinking strategies focused on addressing members/medical providers needs and resolving concerns.
- Operated in dynamic, high-volume environments to provide skilled assistance to several members/medical providers each day.
- Examined forms to determine insurance coverage and validity.
- Analyzed information gathered from investigations and reported findings.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Followed up with insured individuals regarding premium and deductibles payments.
- Reviewed medical claims to verify approved or denied status.
- Verified medical claims process accuracy.
- Assisted Spanish speaking member with medical insurance inquiries.
- Maintained worked equipment to enable me to service members/medical providers remotely.
- Multitasked by navigating through several different systems and applications.
- Communicated with coworkers remotely via Microsoft teams Chat and Outlook email.
- Troubleshooted phone/PC system issues.
Bilingual Member/Provider Services Representative/Provider Maintenance Specialist
AmeriHealth Caritas
01.2014 - 01.2023
- Responded to and resolve incoming calls from Medicaid eligible members and providers needing assistance with benefits and claims inquiries
- Assisted members with Prestige and AmeriHealth Caritas Louisiana Medicaid HMO plan benefits inquiries by educating them on health, dental, vision coverage details
- Verified members' eligibility and researched any eligibility issues
- Engaged in provider relations by reviewing claims details to determine payment status or denial reason
- Identify errors in a processed claim and escalate any issues that can't be resolved within parameters to provider claims service department
- Familiarized myself with claim procedure codes and verify prior authorization status in conjunction with claims
- Navigated internal systems to extract provider claim status and update/modify member information
- Verify provider participation status and assist with credentialing issues
- Compiled detailed information from member /provider calls in order to file complaints or grievances and route to proper department for investigation
- Serviced member/provider calls accurately/efficiently while adhering to AmeriHealth Caritas policies and procedures
- Communicate with management to review quality, adherence, average call handle time and attendance goals
- Maintained and updated medical providers demographics and practice information into an internal database
- The maintenance insured medical claims were paid correctly
- These providers were credentialed with the AmeriHealth Caritas North Carolina Medicaid plan.
Mortgage Loan Officer
Bank of America
01.2013 - 01.2014
- Identified, developed and maintained a quality network of business relationships that served as a source of referrals for new mortgage lending opportunities
- Responded to customer inquiries and conducted interviews with prospective borrowers in order to analyze financial objectives
- Advised customers of product/pricing and guidelines.
Investment Specialist
Bank of America/Merrill Lynch
01.2012 - 01.2013
- Maintained a high level of personal integrity and complied with the Guidelines for Business Conduct as stated by Merrill Lynch
- Serviced and maintained Merrill Edge client accounts via phone-based platform
- Specialized in using various systems to obtain, update, and research several different types of client accounts.
Bilingual CSR
Scholarship Foundation, AppleOne Staffing
01.2011 - 01.2012
- Assist parents of children who attend K-12 with applying for step up for student's scholarships via Inbound/outbound calls.
Bilingual Customer Service Representative
Incomm, Contemporary Staffing
01.2010 - 01.2011
- Handled at least 50 inbound calls per day from MasterCard and Visa prepaid cardholders who called to inquire about their account balances, transaction history and card usage.
Education
A.S. in Information Technology - Computer And Information Sciences
Florida State Community College
Jacksonville, FLHigh School Diploma -
All Hallows High School
Bronx, NY06.1996
Skills
- System updates
- Payment Acceptance
- Account Management
- Service Recommendations
- Database Maintenance
- Call Management
- Call center experience
- Customer Service
Languages
Spanish
Native or Bilingual
Timeline
Member/Provider Service Representative
Value Health Benefit Management LLC
07.2023 - 08.2024
Bilingual Member/Provider Services Representative/Provider Maintenance Specialist
AmeriHealth Caritas
01.2014 - 01.2023
Mortgage Loan Officer
Bank of America
01.2013 - 01.2014
Investment Specialist
Bank of America/Merrill Lynch
01.2012 - 01.2013
Bilingual CSR
Scholarship Foundation, AppleOne Staffing
01.2011 - 01.2012
Bilingual Customer Service Representative
Incomm, Contemporary Staffing
01.2010 - 01.2011
A.S. in Information Technology - Computer And Information Sciences
Florida State Community College
High School Diploma -
All Hallows High School
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