Iya Evbuomwan
Houston,TX
Summary
Personable and dedicated customer service representative with 9years extensive experience in industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.
Overview
15
15
years of professional experience
Work History
Claims/Customer Service Representative Team Lead
healthcare silvercrest villages
Cypress, TX
08.2017 - Current
- Handled high volume of incoming calls, providing exceptional customer service to patients and families.
- Attended continuing education seminars related to insurance industry best practices and new legislation.
- Investigated facts, confirmed coverage and liability, negotiated settlements, and determined payments for claims.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
- Handled customer inquiries regarding insurance policy coverage details and payment status updates.
- Resolved complex discrepancies in policyholder files to facilitate accurate claim processing.
- Identified potential fraud indicators during the review process and reported suspicious activity accordingly.
- Analyzed trends in claim denials or delays to identify areas for improvement within the organization.
- Provided clear explanations of benefits, eligibility requirements, and applicable laws when communicating with customers.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Developed strategies to reduce the number of denied or delayed claims within assigned portfolio.
- Documented changes in claim statuses using specialized software systems.
- Interpreted legal documents such as contracts or court orders when evaluating claims for payment.
- Filed appeals on behalf of customers when necessary after denial of a claim due to insufficient evidence.
- Coordinated with repair facilities and contractors to obtain repair estimates and ensure quality services.
- Verified details with policyholders and requested additional information.
- Assisted in the development and updating of claims policies and procedures to improve efficiency.
- Worked closely with underwriting and risk management teams to provide insights from claims experiences.
- Implemented cost-saving measures without compromising on the quality of service or claim outcomes.
- Evaluated and processed insurance claims according to company policies and industry standards.
- Conducted training sessions for new hires on claims processing procedures and best practices.
- Negotiated settlements with claimants and attorneys to resolve claims efficiently and fairly.
- Attended legal proceedings related to claims, including arbitrations and mediations, as required.
- Determined claim validity and assessed liability and damages to calculate appropriate compensation.
- Interpreted and applied insurance policy provisions to determine coverage for each claim.
- Utilized claims management software to track claims progress and maintain organized documentation.
- Facilitated patient registration, verifying all required documentation is collected and filed properly.
- Participated in training sessions to stay updated on healthcare policies and registration software.
- Conducted financial counseling for patients, explaining payment options and assistance programs.
- Guided patients through the completion of consent and other required medical forms.
- Supported emergency department registration during peak times, ensuring rapid patient processing.
- Enhanced productivity and customer service levels by anticipating needs and delivering outstanding support.
- Increased customer satisfaction ratings by effectively answering questions, suggesting effective solutions, and resolving issues quickly.
- Presented existing and prospective customers with valuable service or product information to aid in decision-making.
- Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
- Oversaw warranty counseling process to manage expense controls.
- Adjusted bills and refunded money to resolve customers' service or billing complaints.
- Prepared and evaluated CRM reports to identify problems and areas for improvement.
Healthcare Customer Service Representative
tripplestar llc
Houston, Texas
07.2012 - 07.2017
- Prepared and evaluated CRM reports to identify problems and areas for improvement.
- Excelled in exceeding daily credit card application goals.
- Assisted customers with price checks, lifting heavy items and addressing other inquiries.
- Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
- Collected deposits or payments and arranged for billing.
- Collaborated with sales team members to stay current on inventory levels and resolve item issues.
- Increased customer satisfaction ratings by effectively answering questions, suggesting effective solutions, and resolving issues quickly.
- Recommended improvements in products, service and billing methods to management to prevent future problems.
- Adjusted bills and refunded money to resolve customers' service or billing complaints.
- Enhanced productivity and customer service levels by anticipating needs and delivering outstanding support.
- Took special orders in person and over telephone, generating additional revenue every month.
- Conferred with customers by telephone or in person to provide information about products or services and take orders.
- Strengthened customer retention by offering discount options.
- Updated databases with new and modified customer data.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Led on- and off-site customer support teams across multiple time zones.
- Contacted customers about potential service upgrades, new services and account changes.
- Liaised between customers and retail buyers to expedite orders and meet customer demands.
- Exceeded established service goals while leveraging customer service, sales and employee management best practices.
- Determined accurate prices for customer services, consistently searching for deals and best prices.
- Updated system with order specifics and customer details, preferences, and billing information.
- Provided top quality control and eliminated downtime to maximize revenue.
- Supported sales team members to drive growth and development.
- Promoted available products and services to customers during service, account management and order calls.
- Presented existing and prospective customers with valuable service or product information to aid in decision-making.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Utilized job-related software to prepare change of address records and issue service discontinuance orders.
- Oversaw warranty counseling process to manage expense controls.
- Surpassed sales goals through implementation of successful marketing strategies.
- Prevented key account losses by researching discrepancies and correcting problems.
- Coordinated with internal teams to ensure timely and successful delivery of solutions according to client needs.
Healthcare Customer Service Representative
Divine Health Care
Houston, TX
02.2010 - 03.2012
- Utilized active listening and communication skills to address customer inquiries and escalate issues to supervisor.
- Managed customer inquiries through telephone, email and social media interfaces.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Communicated financial obligations to patients and collected fees at time of service.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Applied HIPAA privacy and security regulations while handling patient information.
- Processed patient responsibility estimate determined by insurance at pre-registration.
- Collaborated with insurance companies to resolve billing discrepancies and pre-certification issues.
- Processed patient co-pays, deductibles, and other payments, ensuring accurate financial records.
- Monitored waiting areas to ensure a comfortable and safe environment for patients and visitors.
- Coordinated with clinical staff to manage patient flow, reducing wait times and improving satisfaction.
- Coordinated scheduling of appointments across multiple departments to optimize patient care.
- Assembled registration paperwork and placed identification bands on patient.
- Provided directions and information to patients and families, enhancing their hospital experience.
- Reviewed eligibility responses to assess patient benefit level and prepare estimates.
- Supported emergency department registration during peak times, ensuring rapid patient processing.
- Guided patients through the completion of consent and other required medical forms.
- Assisted in the implementation of new technologies and processes to improve patient access services.
- Prepared daily reports on registration activities, highlighting areas for improvement.
- Registered patients by completing face-to-face interviews to obtain demographic, insurance, and medical information.
- Utilized hospital systems to update patient records, ensuring accuracy and completeness.
- Kept patient appointments on schedule by notifying providers of patients' arrival and reviewing service delivery compared to schedule.
- Processed insurance verifications and authorizations to ensure coverage of services.
- Contributed to team meetings, sharing insights and strategies for improving patient access services.
- Facilitated patient registration, verifying all required documentation is collected and filed properly.
- Handled high volume of incoming calls, providing exceptional customer service to patients and families.
- Participated in training sessions to stay updated on healthcare policies and registration software.
- Addressed patient inquiries and concerns, resolving issues in a timely and empathetic manner.
- Managed patient check-in process, ensuring accurate data entry of personal and insurance information.
- Explained various admission forms and policies, acquiring signatures for consent.
- Verified demographics and insurance information to register patients in computer system.
Education
MBA - Business Administration And Management
Madonna University
Okija Anambra State09-2009
Skills
- Medical terminology knowledge
- Follow-up skills
- Strong interpersonal skills
- Insurance Verification
- Claims Processing
- Record maintenance
- Appointment Scheduling
- Pre-Admission Requests
- Financial Procedures Adherence
- Registration management
- HIPAA Compliance
- Customer Service
- Training Coordination
- Quality Assurance
- Scheduling Diagnostic Procedures
- Problem-Solving
- Stress Tolerance
- Policy Adherence
- Multitasking and Organization
- Insurance company knowledgeable
- Patient Education
- Post-Discharge Care Coordination
- Work Quality Evaluation
- System Updating
- Payment Processing
- Process Improvement
- EMR
- Team Collaboration
- english Fluency
- Call Screening
- Relationship Building
- Medical Billing
- Phone and Email Etiquette
- Patient Registration
- Flexible Schedule
- Information Collection
- Insurance Billing
- Regulatory Compliance
Timeline
Claims/Customer Service Representative Team Lead
healthcare silvercrest villages
08.2017 - Current
Healthcare Customer Service Representative
tripplestar llc
07.2012 - 07.2017
Healthcare Customer Service Representative
Divine Health Care
02.2010 - 03.2012
MBA - Business Administration And Management
Madonna University
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