KaSheena Ruffin
Summary
Experienced with insurance verification processes, ensuring accurate and timely handling of patient information. Utilizes strong analytical skills to identify and resolve discrepancies, maintaining seamless operational flow. Knowledge of industry regulations and best practices, contributing to overall efficiency and reduced claim rejections.
Overview
18
18
years of professional experience
Work History
Quality Assurance – Insurance Verification
Globe Life
02.2024 - Current
- My responsibilities include making over 100 outbound calls per day, while accepting inbound calls to verify insurance applications.
- I contact Globe Life applicants to complete health assessments and insurance verifications for underwriters.
- I'm responsible for making complete and accurate documentation on all calls.
- I must successfully meet the minimum expectations for all departmental KPI's
- I contact potential members to investigate discrepancies in their answers on health assessments vs. their actual health records.
- I work independently and manage my time wisely.
- I follow all quality scripts to make sure I adhere to HIPPA guidelines.
- Work From Home
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Excellent communication skills, both verbal and written.
Care Navigator
United Healthcare
05.2023 - 11.2023
- Work From Home- Contractor
- Maintained confidential health information according to state and federal regulations.
- Educated member on gaps in care and assisted with scheduling provider appointments.
- Assisted members with social determinants of health and linked to appropriate community resources.
- Consistently maintained confidentiality while handling sensitive patient information in accordance with HIPAA guidelines.
- Maintained detailed documentation of patient interactions, treatment plans, and progress notes for accurate recordkeeping.
- Enhanced patient satisfaction by providing comprehensive care coordination and support.
Service Delivery- Order Processing
Windstream
05.2022 - 06.2023
- My responsibilities included creating, changing, upgrading, and disconnecting products for Windstream Enterprise customers.
- This position was 100% Date Entry which required superior time management.
- I reviewed service orders and processed them according to the customer's request.
- Proven ability to learn quickly and adapt to new situations.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
Remote Insurance Verification/Eligibility Specialist
IBM- Accredo
09.2021 - 01.2023
- I was responsible for verifying health insurance benefits for Accredo Specialty Pharmacy.
- I made outbound calls to members, medical offices, PBM's, and insurance companies to verify active coverage as well as coordination of benefits.
- I completed as much research as necessary to make sure I'm able to verify that a member's medication will be covered.
- I was responsible for running test claims to determine copays and out of pocket expenses.
- I requested prior authorizations from medical providers for specialty medications.
- I'm skilled in using Cigna4hcp, Care Central, Trizetto, Availity, RPA, as well as several other eligibility and electronic medical record tools.
- Work From Home- Contractor
Remote Customer Service Specialist
VERIZON WIRELESS
11.2020 - 08.2021
- I provided expert level customer service to Verizon Wireless customers.
- I was responsible for assisting with all of the customers needs ranging from sales, billing, tech support, and online application support
- I assisted customers with adding or modifying services such as: Adding new devices, new lines of service, port in request, and disconnects.
- As a VTeamer, I also assisted my teammates when they need help finding a resolution.
- I assisted Verizon retail representatives with complicated account, billing, and activation issues that they aren't able to resolve on their own.
- Work From Home
DOJ Rep 1 Field Operations Support – Last Position
SPECTRUM
08.2017 - 08.2020
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
- Learned and followed all organizational policies and procedures to maintain safe and professional working environments.
- Increased customer satisfaction by addressing and resolving complaints in a timely manner.
CCR III – Account Services
Suddenlink Communications
03.2013 - 07.2017
- Assist customers with billing inquiries
- Schedule appointments and service changes as needed
- De-escalate calls while providing great customer service
- Triage Technical Dispatcher/ Dispatcher 1- Final Position
- I found and resolved avoidable truck rolls related to: residential Internet/home networking/phone/cable issues and outages commercial Internet/multi-line phones/business networks/cable issues and outages
- I educated customers on their personal electronic devices such as Routers, Ethernet cords, modems, wireless adapters, tv's, mobile devices, gaming devices, switches, and setting up network bridges.
- I handled customer escalation calls when they are upset about the trouble they're experiencing or problems that have been caused by our technicians.
Office Manager
J & C Property Investments LLC
08.2012 - 07.2017
- I made bank deposits when we received tenant payments
- I performed data entry of all transactions into our systems
- I spoke with tenants and made payment arrangements
- I ran background checks and verified employment and criminal records for all tenants using different online software.
- I was responsible for contacting maintenance personnel for service calls.
Utility Debt Collector
Online Collections
09.2011 - 11.2012
- Collected debt for several utility companies
- I processed payments and set up pay arrangements
- I achieved my goal 10/12 months
Assistant Manager
Handy Mart
04.2007 - 03.2012
- I was responsible for opening/ closing the store
- I was responsible for making the schedule weekly
- I made daily bank deposits
- I made sure my team worked as a team
- I interviewed and drug tested new hires.
CSRII Video Tech Support Charter
Convergys
11.2007 - 06.2009
- Some sales
- Assisted customers with cable issues
- Scheduled trouble calls as needed
Education
High School Diploma -
J.H. Rose High School
Greenville, NC01.2004
Skills
- Service excellence
- Problem-solving
- Flexible and adaptable
- Reliable and accountable
- Proficient in handling multiple tasks
- Active listening
- Skilled in digital tools
- Prioritization and scheduling
- HIPAA compliance
- Insurance coverage verification
- Data entry proficiency
- Coverage and authorizations
- Coordination and scheduling
- Electronic medical records
- Medical terminology
- Claims processing
- Remote support
- Product troubleshooting
- Call center operations
Timeline
Quality Assurance – Insurance Verification
Globe Life
02.2024 - Current
Care Navigator
United Healthcare
05.2023 - 11.2023
Service Delivery- Order Processing
Windstream
05.2022 - 06.2023
Remote Insurance Verification/Eligibility Specialist
IBM- Accredo
09.2021 - 01.2023
Remote Customer Service Specialist
VERIZON WIRELESS
11.2020 - 08.2021
DOJ Rep 1 Field Operations Support – Last Position
SPECTRUM
08.2017 - 08.2020
CCR III – Account Services
Suddenlink Communications
03.2013 - 07.2017
Office Manager
J & C Property Investments LLC
08.2012 - 07.2017
Utility Debt Collector
Online Collections
09.2011 - 11.2012
CSRII Video Tech Support Charter
Convergys
11.2007 - 06.2009
Assistant Manager
Handy Mart
04.2007 - 03.2012
High School Diploma -
J.H. Rose High School
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