Karneisha House

• Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customers
• Identifies and resolves operational problems using defined processes, expertise and judgment
• Investigate enrollment, billing, claim and/or customer service issues as identified and communicate resolution to customers
• Provide feedback to team members regarding improvement opportunities
• Provides expertise and customer service support to members, customers, and/or providers
• Responsible for the overall delivery of benefits and services by providing support and guidance to existing and potential customers to ensure continued membership
• Influence others to meet expected service levels and deadlines
• Act as a departmental resource (Subject Matter Expert) on appeals matters.
• Perform as an On the Job Trainer for new hires.

• Serve as a resource or Subject Matter Expert (SME) for other team members or internal customers

• Handle escalated calls, resolving more complex customer issues in a one and done manner

• Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)

• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems

• Intervene with care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed

• Assist customers in navigating UnitedHealth Group websites and encourage and reassure them to become self-sufficient

• Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member

• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues

• Provide education and status on previously submitted pre-authorizations or pre-determination requests

• Meet the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance

• Responded to customer needs through competent customer service and prompt problem-solving.
• Assisted call-in customers with questions and orders.
• Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions.
• Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
• Navigated multiple computer systems and applications to find information.

• Supervised staff successfully, utilizing effective communication and dynamic interpersonal skills.
• Worked jointly with team members to assist with closing sales, cross-selling and upselling of products and services.
• Effectively coached team members to reach weekly and monthly sales goals.
• Promoted exceptional customer service by engaging clients on sales floor.

• Checks-in patients in a timely manner. Ensures all Web Check-in procedures are followed

• Answers phone calls to the clinic and provides information or refers questions to others as needed • Verifies insurance timely and accurately

• Ensures the occupational client preference card is followed and occupational procedures

• Reviews all patient paperwork to ensure completeness and insures collection of necessary insurance / demographic information

• Completes Daily Balance Checklist after each shift. Includes all forms of payment are accounted for and documented

• Prepared insurance claim forms, explained benefits, and outlined pricing details for procedures and services.
• Adhered to strict HIPAA guidelines to protect patient privacy.
• Provided excellent customer service to create positive experiences and build patient trust.
• Scheduled, rescheduled, and cancelled appointments for dental patients.

• Managed office within budget guidelines for clerical and auxiliary supply purchases, equipment upgrades and labor costs.
• Recruited, hired and developed office teams to offer best-in-class patient care.
• Supervised and led team of dental assistants and support staff of 10.
• Increased and stimulated new patient growth by supporting sales, marketing and promotional programs.

• Managed inventory and receiving operations to maintain optimal stock levels and meet expected demands.
• Communicated with managers of other departments to maintain transparency.
• Worked actively with management team to create daily and weekly sales plans based on weekly sales trends.
• Created and enforced department policies, procedures and standards to establish productivity and quality.
• Partnered with merchandising team to plan and execute floor moves, merchandise placement, and overall sales set-up.

• Organized racks and shelves to maintain store visual appeal, engage customers, and promote specific merchandise.
• Helped customers locate products and checked store system for merchandise at other sites.
• Prepared merchandise for sales floor by pricing or tagging.
• Rotated stock and restocked shelves to maintain product availability and store appearance.

• Transported merchandise to sales floor and restocked shelves, racks and bins.
• Removed damaged, out-of-code, not-in-set and discontinued items from displays.
• Greeted, serviced and thanked all customers.
• Answered customer questions regarding store merchandise, department information, and pricing.

• Resolved customer complaints and issues and offered thoughtful solutions to maintain customer satisfaction.
• Assisted in recruiting, hiring and training of team members.
• Interacted well with customers to build connections and nurture relationships.
• Scheduled employees for shifts, taking into account customer traffic and employee strengths.
• Monitored daily cash discrepancies, inventory shrinkage and drive-off.