Summary
Overview
Work History
Education
Skills
Timeline
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Idaysia Jackson

Bryan,TX

Summary

Knowledgeable and dedicated customer service professional with extensive experience in data accuracy, medical insurance and retail sales industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.

Overview

10
10
years of professional experience

Work History

Healthcare Care Advisor (Special Needs)

United Healthcare Group
03.2023 - Current
  • Worked one on one with special need families and individual members with complex health issues.
  • Managed between 50-80 open cases weekly and over 200+ individual/families.
  • Reviewed, analyzed and processed complex grievances and appeals.
  • Followed up with members on unresolved issues and getting them resolved promptly.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Explained benefits to plan members in easy to understand terms in order to educate each on available options.
  • Submitted electronic/paper claims documentation for timely filing.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Communicated with patients and providers to collect information about prescriptions and medical conditions for prior authorizations and pre determinations.

Customer Advocate I

Blue Cross Blue Shield
08.2021 - 08.2022
  • Responsible for responding to telephone and or/written inquiries, working independently and consistently meeting customer needs.
  • Receive, research and process information from members or providers to determine needs/wants and ensure customer questions have been addressed.
  • Researched and resolved account and service problems with friendly, knowledgeable support.
  • Documented customer concerns and inquiry resolutions in internal computer system.
  • Claim copies, claim history data, Explanation of benefits (EOBs)
  • Collaborate with providers, families, and patients by ensuring communication is open and information appropriately shared (in compliance with HIPAA) to ensure member’s and providers' needs are met
  • Assist members in assessing tools and decision-making around complex health issues, e.g
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other corporate and departmental policies
  • Maintain complete confidentiality of company business.
  • Accessed multiple databases to investigate customer questions and concerns.
  • Listened to customers in actively to assess issues and provide accurate information.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Educated customers about billing, payment processing and support policies and procedures.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.

Customer Service Manager

Wal-Mart Super Center
12.2013 - 09.2016
  • Supervised employees and assessed performances to determine training needs and define accurate plans for decreasing process lags.
  • Prepared cash registers for clerks & provided monetary change to cashiers.
  • Resolved customer complaints while prioritizing customer satisfaction and loyalty.
  • Trained and regularly mentored associates on performance-oriented strategies and customer service techniques.
  • Collected customer feedback and made process changes to exceed customer satisfaction goals.
  • Created customer support strategy to increase customer retention.
  • Reviewed repeated issues within operations and business management to solve problems and improve company outcomes.
  • Developed documentation and logs of implemented solutions and generated and submitted reports.
  • Built partnerships with diverse internal teams and sales, finance and operations departments to streamline processes.
  • Conferred with sales teams and team leaders to communicate targets, boost revenue and improve promotional strategies.
  • Coordinated resolutions for more than 50- daily customer inquiries while consistently achieving performance targets.
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.

Education

Associates Degree - In-Progress

Blinn College
Brenham, TX
2024

High School Diploma -

Travis B. High School
Bryan, TX
06.2013

Skills

  • Efficient and Detail-Oriented
  • Accountable and Dependable
  • Critical Thinker
  • Building Customer Trust and Loyalty
  • Responding to Difficult Customers
  • Problem Resolution
  • Calm and Professional Under Pressure
  • Client Relationships
  • Quality Assurance
  • Claims Investigations
  • Customer Support
  • Effective Customer Service
  • Team Leadership and coaching
  • Customer Support
  • Effective Customer Service
  • Team Leadership and coaching

Timeline

Healthcare Care Advisor (Special Needs)

United Healthcare Group
03.2023 - Current

Customer Advocate I

Blue Cross Blue Shield
08.2021 - 08.2022

Customer Service Manager

Wal-Mart Super Center
12.2013 - 09.2016

Associates Degree - In-Progress

Blinn College

High School Diploma -

Travis B. High School

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Idaysia Jackson