Frances Davis
McAlester,OK
Summary
Hardworking employee with many years customer service experience, multitasking and time management abilities. Knowledge of both corporate and consumer collections. Healthcare benefits and claims explanations. Devoted to giving every customer a positive experience.
Overview
26
26
years of professional experience
Work History
Member Care Advocate-Remote
Medwatch, LLC
Lake Mary, FL
11.2022 - 01.2024
- Presented existing and prospective members with valuable insurance benefit information for them to learn about their plan options and have a better understanding of their healthcare coverage.
- Explained claims explanation of benefits to members so that could know how their patient responsibility worked with their schedule of benefits based on their plan summary of benefits.
- Negotiated procedure pricing and resolved balance billing issues with providers concerning claims.
- Verified claims allowed and paid amounts and forwarded for adjustments or reprocessing, when applicable.
Member Care Specialist-Remote
Humana Business Government dba Tricare
Louisville, KY
11.2017 - 10.2022
- Provided assistance and information to members regarding insurance benefits, differences in plans, claims explanations,adjustments, and assistance finding providers.
- Assisted providers with credentialing website and information needed to become a network provider.
- Assisted in training providers on website explaining how to find benefits, eligibility and submit claims.
Customer Care Representative
Avaya Inc
Oklahoma City, OK
02.1998 - 10.2017
- Developed effective relationships with all call center departments through clear communication.
- Addressed customer service inquiries in a timely and accurate manner
- Provided cross training to 50 staff members.
- Trained staff on how to improve customer interactions.
- Provided accurate and appropriate information in response to customer inquiries.
- Worked in several departments including inbound/outbound calls, billing, collections, disputes.
- Provided Management Relief when Group Manager was out of office.
Accomplishments
- Customer/Member satisfaction recognition and increased customer loyalty.
- Knowledgeable in billing, claims, pre-certifications and disputes
- Exceeded corporate target for customer satisfaction.
- Exceeded collection goals on a monthly basis.
Skills
Accounts Payables and Receivables, Collections-both business and individuals, Balance Billing, Call Center Operations, Conflict Resolution, Critical Thinking, Customer Satisfaction, Excellent Customer Service, Microsoft Office, Business Processes, SAP, Salesforce, Medical insurance benefits and claims, Medical credentialing and electronic claims submission, HIPAA knowledge, Tier 1 technical assistance
Timeline
Member Care Advocate-Remote
Medwatch, LLC
11.2022 - 01.2024
Member Care Specialist-Remote
Humana Business Government dba Tricare
11.2017 - 10.2022
Customer Care Representative
Avaya Inc
02.1998 - 10.2017
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