Heather Johnson

PSU Claims

• Answered inbound calls and chats from medicaid members and providers
• Verified benefits and eligibility
• Reviewed authorization statuses
• Reviewed claims with providers
• Provide denial reasoning, appeal rights, timeframes and methods
• Filed verbal appeals for denied claims, authorizations and complaints
• Provided appeal statuses
• Faxed EOP's and authorizations
• Medicare cross-trained

Member Services

• Provide assistance via phone and chat to Medicaid members and providers
• Eligibility and benefits inquiries
• Authorization status
• Provider lookup/Network status
• ID card requests
• Document requests
• Medical appeal submissions/statuses
• Grievance and complaint submission and statuses
• Coordination of benefit update requests
• Cross trained in Medicare advantage plans
• Referrals for health plan extra benefits

Auto Insurance

• Responded to customer requests for products, services, and company information.
• Reviewed and adjusted customer coverage levels to address, identify, and resolve customer conflicts.
• Answer inbound calls and field questions pertinent to existing insurance policies and determine appropriate course of action
• Document detailed specifics of call interaction
• Process endorsements and Department of Motor Vehicle filings
• Answer billing questions
• Process payments for Good Sam/RV, rural letter carrier, traditional auto and agency policies

Holiday Assistance

• Provide customer support through email, inbound phone calls, live chats and text messaging
• Provided information regarding customers' orders and or warranty information
• Processed product orders and provided prompt and efficient responses
• Provided resolutions to customers requests/complaints
• Analyzed, reviewed and processed customer requests for returns/refunds
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Worked my way up from server to bartender to management

• Hire, train and supervise restaurant employees
• Create staff schedule to ensure appropriate staffing
• Track inventory levels of food, alcohol, supplies and equipment
• Address customer needs, comments and complaints
• Adhere to and enforce employee compliance with health, safety and sanitation standards
• Process payroll and maintain all relevant records
• Ensure all employees are working within outlined operating standards
• Take deposits to bank daily

• Investigate freight claims
• Review freight contracts
• Document findings
• Request additional information by phone/e-mail
• Set up appointments for damaged freight to be picked up
• Process claims in accordance to contracts and NMFTA guidelines

Adjustable Bed Division

• Provide timely responses to customers/stores by telephone and/or email in inbound call service center
• Handled between 60-120 incoming calls.
• Provided technical support/troubleshooting
• Part and accessory sales
• Key parts requests and service requests to process and bill before shipping
• Assign technicians to warranty claim services
• Email/fax work order requests to technicians.

• Served food and beverages promptly with focused attention to customer needs.
• Worked with POS system to place orders, manage bills, and handle complimentary items.
• Cultivated warm relationships with regular customers.
• Maintained clean and organized dining areas to uphold restaurant hygiene standards.

Non-profit organization Internship

• Documented findings and prepared detailed reports.
• Carefully documented statements, observations, and evidentiary materials.
• Worked closely with law enforcement and social service agencies in locating missing children that were at risk of being exploited into human trafficking
• Participated in homeless outreaches and provided placement into local shelters
• Followed up with victims and provided information to help apply for available resources

• Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
• Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
• Monitored workflow to improve employee time management and increase productivity.
• Evaluated employee performance and coached and trained to improve weak areas.