Julie Franklin
Fayetteville,NC
Summary
Seasoned Appeals Specialist with background in legal document preparation, claims resolution, and client advocacy. Possess strong skills in negotiation, conflict resolution, and regulatory compliance. Committed to maintaining up-to-date knowledge on industry standards and procedures for effective leadership.
Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.
Overview
7
7
years of professional experience
Work History
M&R Advocate4me/Appeals Specialist
United Healthcare Group
Minneapolis, Minnesota
08.2022 - 05.2025
- Reviewed appeal cases for accuracy and compliance with company policies.
- Collaborated with healthcare providers to gather necessary documentation for appeals.
- Researched regulations to ensure adherence to federal and state guidelines.
- Communicated effectively with clients regarding the status of their appeals.
- Documented appeal findings in the case management system accurately.
- Advised customers on best practices for submitting complete documentation along with their appeal requests.
- Demonstrated ability to work independently as well as collaboratively within a team environment.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Assisted customers with the appeals process, including providing guidance on how to submit an appeal.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Identified needs of customers promptly and efficiently.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Assisted with customer requests and answered questions to improve satisfaction.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Worked with cross-functional teams to achieve goals.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Recognized by management for providing exceptional customer service.
- Utilized various software and tools to streamline processes and optimize performance.
Customer Service Representative
Eclerx
Fayetteville, North Carolina
01.2018 - 07.2022
- Assisted customers with inquiries via phone and email communication.
- Resolved customer issues by troubleshooting and providing effective solutions.
- Documented customer interactions in the ticketing system for accurate records.
- Maintained knowledge of company policies and procedures to support customers effectively.
- Educated customers on product features and services offered by the company.
- Collaborated with team members to improve service delivery processes.
- Answered customer inquiries and provided accurate information regarding products and services.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Developed strong customer relationships to encourage repeat business.
- Developed strong relationships with customers by providing personalized assistance and support.
- Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Informed customers about billing procedures, processed payments, and provided payment option setup assistance.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Gathered customer feedback through surveys and used the data to improve customer service.
- Developed positive relationships with customers through friendly interactions.
- Provided exceptional customer service to ensure customer satisfaction.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Utilized job-related software to prepare change of address records and issue service discontinuance orders.
- Mentored junior team members and managed employee relationships.
- Increased customer satisfaction ratings by effectively answering questions, suggesting effective solutions, and resolving issues quickly.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Answered inbound calls, chats and emails to facilitate customer service.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Used approved scripts to de-escalate angry customers during telephone interactions.
- Answered customer inquiries via phone, email, and chat.
- Provided accurate information about products and services to customers.
- Maintained a high level of professionalism when dealing with difficult customers.
Education
Bachelor of Science - Health Administration
Ashford University
San Diego, CA07-2013
Associate of Applied Science - General Office Technology
Fayetteville Technical Community College
Fayetteville, NC07-1995
Skills
- Regulatory compliance
- Case management
- Documentation accuracy
- Claims analysis
- Data entry
- Customer service
- Communication skills
- Problem solving
- Attention to detail
- Collaboration skills
- Time management
- Interpersonal skills
- Conflict resolution
- Research skills
- Software utilization
- Appeals process proficiency
- Professionalism and ethics
- HIPAA compliance
- Effective communication
- Problem-solving capacity
- Continuous learning mindset
- 10-key touch
- Teamwork
- Office equipment operation
- Detail orientation
- Teamwork skills
- Investigation support
- Patient rapport
- Skilled in [software]
- Relationship building
- Adaptability and flexibility
- Multitasking capacity
- Self motivation
Timeline
M&R Advocate4me/Appeals Specialist
United Healthcare Group
08.2022 - 05.2025
Customer Service Representative
Eclerx
01.2018 - 07.2022
Bachelor of Science - Health Administration
Ashford University
Associate of Applied Science - General Office Technology
Fayetteville Technical Community College