Janisha Edwards

• Answer and manage a large number of inbound calls from patients, providers, and insurance companies regarding medical benefits.
• Assist members with Medicaid enrollment, benefits clarification, and account inquiries, ensuring compliance HIPAA regulations.
• Provide real-time support for inquiries related to coverage, deductibles, claim status, and copayments.
• Explain policy benefits, including HMO, PPO, Medicare, Medicaid, an employer-sponsored insurance plans. Investigate and provide claim statuses, including approvals, denials, and pending claims.
• Assist with resubmitting claims, processing appeals, and correcting claim errors. Educate patients and providers on Explanation of Benefits (EOB) statements.
• Assisted customers with inquiries, providing accurate information and resolving issues efficiently.

• Answer and manage high-volume inbound calls from customers regarding their benefits and services.

• Provide exceptional customer support, ensuring efficient resolution of inquiries and maintaining satisfaction levels.

• Clearly communicate product features and benefits, demonstrating comprehensive knowledge to customers.

• Professionally address and resolve customer complaints with a focus on solution-oriented outcomes, enhancing overall satisfaction.

• Positions ended to program shut down.

handling customer inquiries via phone, chat, or email

• Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
• Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
• Enhanced customer satisfaction by effectively addressing inquiries and resolving issues.
• Educated customers on product features, enhancing their shopping experience.
• Provided support during peak periods, maintaining high service levels.
• Collaborated with team members to improve workflow and service delivery.
• Processed orders efficiently, contributing to overall customer satisfaction.

• Engage with customers through phone, email, and chat to answer questions, resolve issues, and guide them through the order process.

• Monitor pending orders to ensure they are processed smoothly and delivered on time.

• Use a solutions-focused approach to handle customer needs with optimism and professionalism.

• Act as the "voice of the customer" by reporting recurring issues and feedback to relevant departments.

• Identify and report process gaps or areas for improvement to enhance efficiency and customer experience.