Jaina Stevens
Shubuta,MS
Summary
Customer Service Representative with background in providing exceptional support and resolving customer inquiries. Skilled in communication, problem-solving, and maintaining positive relationships with customers. Demonstrated ability to improve customer satisfaction and loyalty through attentive service and effective issue resolution. Committed to enhancing team performance by sharing knowledge and best practices in customer service operations.
Overview
13
13
years of professional experience
Work History
Customer Service Representative
Everise
Remote, MS
12.2022 - Current
- Facilitated communication between health plan representatives, providers, and members when needed.
- Educated customers about the prior authorization process including applicable deadlines.
- Submitted prior authorization requests electronically or by phone to payers.
- Reviewed prior authorization requests for completeness and accuracy.
- Made outbound calls to insurance companies, patients and physicians to perform eligibility checks for patients.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
- Followed standard processes and procedures for proper escalation of unresolved issues to appropriate internal teams.
Back up Team Lead
Wayne Farms
Jack, AL
01.2012 - 08.2020
- Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
- Trained new staff in relevant processes and procedures.
- Delegated tasks appropriately according to individual skill sets.
- Completed daily paperwork accurately and in a timely manner.
- Followed detailed instructions from supervisor regarding tasks assigned.
Education
High School Diploma -
George Jenkins High School
Lakeland, FL05-2003
Skills
- Prior authorization
- Medical terminology
- Microsoft Excel
- Microsoft outlook
- Medical review
- Electronic submissions
- Customer education
- Problem solving
- Time management
- Inbound and outbound calling
- Micro soft word
- Positive and professional
Timeline
Customer Service Representative
Everise
12.2022 - Current
Back up Team Lead
Wayne Farms
01.2012 - 08.2020
High School Diploma -
George Jenkins High School