Summary
Overview
Work History
Education
Skills
Timeline
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JNika Thomas

JNika Thomas

Summary

Professional Call Center Customer Service Representative committed to providing courteous, prompt, detailed, and accurate support. Experience managing outbound and inbound calls and handling emergency issues with patience and tact.


Overview

15
15
years of professional experience

Work History

Inbound Customer Service Representative

Centene
03.2022 - Current
  • Used Microsoft Office tools to track customer experiences, communication, and marketing efforts
  • Answered over 100+ calls per shift to meet fast-paced call center demands.
  • Resolved complaints to satisfy customers and encourage future transactions.
  • Answered phone with friendly greeting to create positive inbound calling experience for customers.
  • Adhered to company policies and scripts to consistently achieve call-time and quality standards.
  • Optimized customer support by establishing collaborative service environments through targeted operational initiatives.
  • Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
  • Stayed calm under pressure to and successfully dealt with difficult situations.

Patient Access Representative

Mercy Hospital
05.2018 - 03.2022
  • Coordinated with 8 insurance companies to provide estimates to patients before their visits
  • Organized and scheduled 50+ weekly patient visits, sending follow-up reminders, and welcoming patients
  • Processed and filed 500+ monthly patient insurance claims for reimbursement
  • Operated 8-line phone system, answering calls and communicating with patients and vendors
  • Applied administrative knowledge and courtesy to explain procedures and services to patients.
  • Engaged with patients to provide critical information.
  • Processed payments using cash and credit cards, maintaining accurate records of transactions.
  • Greeted and assisted patients with check-in procedures.
  • Compiled and maintained patient medical records to keep information complete and up-to-date.
  • Organized patient records and database to facilitate information storage and retrieval.
  • Answered incoming calls, scheduled appointments and filed medical records.

Prior Authorization Specialist

Express Scripts Inc
02.2012 - 05.2018
  • Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
  • Researched denied claims and contacted insurance companies to resolve these issues.
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
  • Reviewed applications for different aid programs and determined which qualification criteria for individuals.
  • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
  • Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.

Customer Service Advocate

United HealthGroup
01.2010 - 02.2012
  • Answered inquiries, provided direction, and screened 50+ daily callers to ensure timely response and resolution
  • Managed customer returns and complaints with an understanding demeanor, increasing customer brand loyalty
  • Followed up with customers about resolved issues to maintain high standards of customer service.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
  • Educated customers about billing, payment processing and support policies and procedures.
  • Dispatched customer calls to appropriate company departments for unresolved questions and concerns
  • Resolved associate, tool and service delivery issues revealed by statistical reports.
  • Built long-term, loyal customer relations by providing top-notch service and detailed order, account, and service information.
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.

Education

Associate of Nursing - Nursing

Saint Louis College of Healthcareers
Saint Louis, MO
05-2022

Skills

  • Effective Verbal Communication
  • Meticulous Attention to Detail
  • Critical Thinking Skills
  • Supportive Engagement
  • Data Interpretation
  • Prioritization and Time Management
  • Effective Conflict Resolution
  • Flexible Problem-Solving
  • Technical Proficiency
  • Proficient in Microsoft Applications
  • Medical terminology

Timeline

Inbound Customer Service Representative

Centene
03.2022 - Current

Patient Access Representative

Mercy Hospital
05.2018 - 03.2022

Prior Authorization Specialist

Express Scripts Inc
02.2012 - 05.2018

Customer Service Advocate

United HealthGroup
01.2010 - 02.2012

Associate of Nursing - Nursing

Saint Louis College of Healthcareers

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JNika Thomas