JEANIE MCDANIEL
Riverview
Summary
Astute Call Center professional offering polished communication skills. Brings excellent organizational skills and talent for overcoming customer objections. Self-motivated and true team player.
Overview
20
20
years of professional experience
Work History
Contact Center Representative
Adecco Staffing
11.2023 - Current
- Professionally answered callers and addressed callers with inquiries as needed
- Routed calls as needed to appropriate resources/department
- Identify and escalated more complex issues to the research team for assistance/support
- Completed necessary administrative work as needed and completed call logs accurately.
Cobra Data Entry
Paychex
06.2021 - 11.2023
- Update employees work status in the power builder system
- Inform termed employees of their option to continue health coverage through Cobra
- Mail Cobra material regarding premiums, plan options and monthly payments to potential members.
Sr. Customer Care Analyst
Liberty Dental Plan
02.2017 - 05.2021
- Educate members on their rights and responsibilities, the complaint and appeals process, and the medically necessary covered dental services that are available to them
- Work with Compliance, Dental Consultant and Management teams when appropriate to apply appropriate solutions and timeframes
- Perform daily review, analysis, trending and corrective action of prior day’s call tracking records
- Work to resolve member/provider dissatisfaction within established timeframes
- Commit to responding within 72 hours to all inquiries routed through the CCU regardless of the communication route (e.g., HSP inquiry/workflow, Email, Fax, phone call, etc.)
- Emergency cases turnaround time is within 24 hours
- Compose comprehensive written responses to all inquiries
- Assist the call center with meeting performance guarantees, help desk, training, and miscellaneous duties as assigned
- Perform other duties as assigned or determined appropriate G & A queue – daily research of case, calls to member and/or providers submitting claims to be processed based on outcome of case
- Provider directory requests are complete within 24 hours – Submitting provider directory request to be mailed to members Tele dentistry – Make sure members who contact Liberty regarding overnight or weekend dental issues has been assigned to a specialist to assist and resolve
- Customer Service Inbox - Review the disputes and send emails to specific sites, FL, CA and Nevada to be completed
- HSP Triaging – Reviewing cases in our call, claims platform and assigning to analyst Assigning Cases per workflow Queues Escalation Calls, manage the queue and provide resolution Daily team call with the Customer Care Analyst’s to provide daily support and build a positive working relationship Assist the CCA Analyst with any issues or concerns pertaining to a case/cases Research for possible in/out of network providers to assist with dental care for case management
- Assist with claim issues pertaining to OON providers
Well care Insurance Intake Coordinator
Teleperformance Inc.
04.2014 - 08.2016
- Proficient in Emma Data Software Inpatient & Outpatient, Medicare/Medicaid, ICD 9 Codes, CPT procedure codes, locating treating providers, requesting providers, review nurses, hospitals & facilities
- Ensure that policy requirements fulfilled, including any necessary medical examinations and the completion of authorization forms
- Attend meetings and programs to learn about new products and services, learn new skills, and receive technical assistance in developing new accounts
- Call on nurses and doctors to explain policy, to analyze insurance and suggest additions.
Customer Service Specialist
HUMANA
01.2007 - 01.2013
- Provide excellent customer assistance to existing members as it pertained to their benefits and claim status
- Answered inquires of eligibility and benefits of utilizing Humana to potential member and Medicare/Medicaid Providers
- Assisted with project on Section A complaints against Sales Agents regarding misleading information given to members
- Assisted with project on repeat callers, researching root cause of calls and determining the best resolution.
Receptionist/Medical Records
CONSULT CARE
04.2004 - 09.2006
- Answer inbound calls made to the practice and greeting/welcoming/engaging each patient occupying the facility
- Facilitate lab work and manage patient follow-up File medical records and process subpoenas
- Performed medical review, which includes verifying all physician's orders for lab and radiology are receive and photocopied
- Process referrals collected copayments and verify insurance coverage.
Education
Associate -
WASHINGTON COUNTY TECHNICAL
ABINGDON, VA03.1983
Skills
- Excellent customer service and related skills
- Exceptional skills with Medicaid & Medicare
- Knowledge of insurance claim procedures
- Proficient in Microsoft Office
- Excellent interposal & communication skills
- Exceptional computer & internet skills
Timeline
Contact Center Representative
Adecco Staffing
11.2023 - Current
Cobra Data Entry
Paychex
06.2021 - 11.2023
Sr. Customer Care Analyst
Liberty Dental Plan
02.2017 - 05.2021
Well care Insurance Intake Coordinator
Teleperformance Inc.
04.2014 - 08.2016
Customer Service Specialist
HUMANA
01.2007 - 01.2013
Receptionist/Medical Records
CONSULT CARE
04.2004 - 09.2006
Associate -
WASHINGTON COUNTY TECHNICAL