KANESHIA TALLEY

As a Care Center II Rep, I'm responsible for maintaining financial records and ensuring that financial transactions are properly recorded. They prepare balance sheets, profit and loss statements, and other financial reports.. They also design and maintain customer accounts, communicate with clients, respond to their concerns, and monitor transactions and payments.. Specific duties include communicating with clients to help resolve issues, maintaining accurate client records, upselling products or services, and being a point of contact through various service stages.

• Demonstrated high energy in interactions with agents and staff.
• Educated agents on billing, payment processing, and support policies, enhancing their ability to assist clients effectively.

• Answer any incoming calls and proactively work queues of pending accounts to be included to ensure the department is meeting business objectives
• Demonstrate analytical and problem-solving ability by addressing barriers to receiving and validating accurate PHI information
• Provide essential support to team spirit, motivation and operation
• Determine contract and benefit eligibility, provide authorizations for admissions
• Refer cases requiring clinical review to Nurse reviewer
• Ensure all compliance policies are followed and maintain productivity and accuracy of records.

• Managed high volume inbound calls and answered questions in regards to billing and services provided
• Accurate and efficient order entry and maintenance of customer files
• Ensured proper protocols were provided for complaints
• Interacted with all levels of management and handled direct requests as assigned
• Built customer loyalty by placing follow-up calls for customer who reported product and handled customer complaints prior to escalation
• Insurance verification, including commercial, government, state, workers compensation and auto insurance
• Exercising of independent judgment and decision-making authority
• Ensured pre-certification and/or authorization was obtained.

• Managed all incoming calls and worked from established scripts and job aids to assist customers
• Collaboration with care management staff to address and resolve needs of members, caregivers and providers
• Recommended products and services to members and accurately explained details of services offered
• Cross-trained and provided back up for other customer service reps when needed
• Dedicated to continuously improving service abilities and product knowledge
• Reported policy changes and company conditions affecting customer satisfaction
• Completed outbound enrollment verification (OEV) calls with all enrollees, generating interest from customers by conveying key product benefits.

• Established and enforced operating procedures and work standards that upheld to high performance
• Used troubleshooting skills to perform daily tasks when clients had issues with online tools
• Assisted with training and development of new employees
• Performed tracking/trending analysis of quality findings and assisted operations
• Provide recommendations in im