Summary
Overview
Work History
Education
Skills
Work Availability
Quote
Timeline
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Keelon James

Fraud Specialist II Executive Resolution
Hazelwood ,Mo

Summary

Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty.

Overview

17
17
years of professional experience

Work History

Service Specialist II Executive Resolution

WayFair
08.2019 - Current
  • While working with Wayfair
  • I started off as a customer service rep
  • I assisted the customers with any issues they had with their order and helped them place orders
  • Within the first month of working I was promoted to Senior Service agents
  • Within this department i assisted in helping with any damaged items the customers would have received, assisted in returns and processing declined payments and I also assist with all business orders.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Analyzed customer service trends to discover areas of opportunity and provide feedback to management.
  • Participated in team meetings and training sessions to stay informed about product updates and changes.
  • Provided primary customer support to internal and external customers.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Clarified customer issues and determined root cause of problems to resolve product or service complaints.
  • Responded to customer requests for products, services, and company information.
  • Updated account information to maintain customer records.
  • Developed customer service policies and procedures to meet and exceed industry service standards.
  • Utilized customer service software to manage interactions and track customer satisfaction.
  • Tracked customer service cases and updated service software with customer information.

Delivery Driver

Amazon Delivery Team
04.2019 - 08.2019
  • While working for Amazon, I was responsible for delivery of customer's orders in a timely and professional manner.
  • Completed on-time deliveries by choosing best and most efficient routes.
  • Delivered packages to customer doorsteps and business offices.
  • Maintained upbeat, positive attitude in busy, customer-focused environment.
  • Completed rush deliveries on tight timetables to satisfy customer needs.
  • Read maps, followed oral, and written instructions and used GPS technology to make deliveries.
  • Operated vehicle safely in highly congested areas with no traffic violations.
  • Worked scheduled hours as required and took on available shifts during holidays and busy periods.
  • Expedited deliveries to meet customer deadlines and requirements.
  • Loaded truck and properly secured items to prevent damage for deliveries.
  • Managed customer inquiries and complaints in polite and professional manner.
  • Verified accuracy of all deliveries against order forms.
  • Inspected and maintained delivery vehicles regularly to keep in safe working order.
  • Communicated with dispatchers to stay informed of changes to routes and delivery schedules.
  • Followed corporate procedures to maintain company and customer data confidentiality.
  • Kept detailed mileage and fuel reports to track overall fuel costs.
  • Successfully avoided time delivery delays by carefully planning best routes.
  • Determined quickest and safest routes for delivery by using effective planning and organizational skills.
  • Worked with road knowledge, GPS systems and paper maps to navigate planned route and make adjustments.
  • Loaded and unloaded various delivery vehicles with correct order and balancing.
  • Promoted customer satisfaction by addressing or escalating concerns for quick resolution.
  • Fostered positive working relationships with regular customers.
  • Answered common customer questions, accepted payments and completed paperwork at delivery and pickup locations.
  • Minimized company liability and risks to loads by obeying traffic laws.

Tier 2 Claims Specialist

United Healthcare, UHC
11.2010 - 04.2019
  • Within the company of me being a Tier 2 Claims Specialist, I have done an excellent job explaining to the members their benefits and also helping them find providers that are in network
  • I worked on a specialty team that processed claims over $10,000
  • I helped with being the commitment champion getting all EOB and claims routed to the appropriate department
  • I assisted with being an OJT Coach quarterly, that helped others learn about the job and how to navigate through the system
  • I am enthusiastic and eager to learn new tasks
  • I am also efficient in Microsoft Office and creating Excel spreadsheets as well as pulling claims from Sharenotes.
  • Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
  • Followed up with customers on unresolved issues.
  • Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
  • Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
  • Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
  • Conducted full claim investigations and reported updates and legal actions.
  • Escalated files with significant indemnity exposure to supervisor for further investigation.
  • Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
  • Negotiated with other involved parties to arrange settlements for maximum results.
  • Provided advice to customers regarding claims, rights and insurance processes to prevent disputes.
  • Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
  • Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
  • Reviewed new files to determine current status of injury claim and to develop plan of action.
  • Utilized appropriate cost containment techniques to reduce overall claim costs.
  • Checked documentation for accuracy and validity on updated systems.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Generated, posted and attached information to claim files.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Processed and recorded new policies and claims.
  • Verified client information by analyzing existing evidence on file.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Modified, updated and processed existing policies.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Notified insurance agents and accounting departments of policy cancellations and changes.
  • Determined appropriateness of payers to protect organization and minimize risk.

Rental Sales Associate

Avis
07.2018 - 01.2019
  • While working at Avis, I assisted customers into getting a rental car and helped process returns that resulted in a positive experience for the customer
  • I also promoted additional products that would be beneficial to the customer.
  • Accommodated last minute requests to address needs of guests, achieving top guest satisfaction and repeat business.
  • Resolved customer disputes to maintain positive relationships and increase customer base.
  • Implemented rental asset processes and cleanliness standards.
  • Drafted quotes, confirmed orders, and managed transfers to handle rental needs efficiently.
  • Optimized guest experience by inspecting properties prior to guest stays, coordinating repairs, and upgrades.
  • Coordinated with sales teams and clients to manage inventory, adjust orders, and handle logistics.
  • Partnered with outside sales to identify critical accounts with growth opportunities.
  • Updated company database with new property listings or added amenities.
  • Managed multiple tasks in high-volume environment.
  • Greeted customers with enthusiasm, offered to take orders and fulfilled each quickly and correctly.
  • Addressed guest complaints and resolved issues to promote satisfaction.
  • Helped train new staff on company policies, procedures and standards, boosting productivity.
  • Determined clients' needs and helped select appropriate rentals fulfilling requirements.
  • Kept up-to-date rental records and customer information in company systems to track client interests and preferences.

Billing Specialist

Herron Consulting Services LLC, Herron, Services LLC
02.2011 - 01.2018
  • I processed claims and researching claims for mental behavior in adolescence for Trinity Social Service
  • I processed the claims and researched them to see why they didn't pay the appropriate amount
  • I researched to see if the proper procedure code or modifier was used when the claim was sent over, and if it was within the appropriate time frame from the date of service
  • Working for this company I learned how to do an audit to make sure everything is paying correctly and what the allowed amount will be for the billing services.
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
  • Monitored customer accounts to identify and rectify billing issues.
  • Provided excellent customer service, developing and maintaining client relationships.
  • Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
  • Worked with multiple departments to check proper billing information.
  • Identified, researched, and resolved billing variances to maintain system accuracy and currency.
  • Processed and verified invoices to secure accuracy of billing information.
  • Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
  • Generated and submitted invoices based upon established accounts receivable schedules and terms.
  • Developed and maintained billing procedures to make timely payments.
  • Reviewed and reconciled customer accounts to manage accuracy of payments.
  • Identified payment trends and adjusted billing processes accordingly to retain customers.
  • Prepared and submitted monthly billing reports to management for financial overview.
  • Responded to customer concerns and questions on daily basis.
  • Generated monthly invoices for customers in multiple formats to provide transparency.
  • Used data entry skills to accurately document and input statements.
  • Handled account payments and provided information regarding outstanding balances.

Inbound call center (Manager

Enterprise Rent-A-Car
05.2006 - 05.2011
  • I assisted in the development of new policies and procedures
  • I also helped training the new customer service representatives and associates
  • I performed market research surveys on customer needs and requirements
  • I was responsible for the supervision of a staff of 15 people within the roadside department when there was no manager in the call center
  • I answered all roadside and customer service calls that came into the call center
  • I was responsible for the recruitment and training of new roadside agents
  • Responsible for all customers with roadside issues
  • I made sure each customer was taken care of and never left on the side of the road.
  • Responded to customer calls and emails to answer questions about products and services.
  • Adhered to company policies and scripts to consistently achieve call-time and quality standards.
  • Placed outbound customer service or customer satisfaction calls to follow up on issues.
  • Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
  • Processed debit and credit card and electronic check payments.
  • Attended telephone skills and program information training sessions to boost aptitude.
  • Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions.
  • Boosted customer service satisfaction ratings through consistent quality control.
  • Educated customers on company systems, form completion, and access to services.
  • Learned and maintained in-depth understanding of product information, providing knowledgeable responses to diverse questions.
  • Sought out extra training opportunities to enhance customer relationship management abilities.
  • Approved and terminated customer contracts upon request.
  • Collaborated with shipping team to track shipments, verify orders and handle product returns.
  • Performed various clerical duties by filing and faxing documents and creating customer databases.
  • Compiled status and performance reports for team leaders to address company strengths and weaknesses.
  • Leveraged sales expertise to promote products and capitalize on upsell opportunities.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Responded to customer requests, offering excellent support and tailored recommendations to address needs.
  • Investigated and resolved customer inquiries and complaints quickly.
  • Bolstered customer retention by creating and offering unique discount options and inspiring interest in new product lines.
  • Managed timely and effective replacement of damaged or missing products.
  • Optimized customer support by establishing collaborative service environments through targeted operational initiatives.

Education

East St Louis Sr. High
2003

Skills

  • Knowledge of
  • HMOs, Medicare and Medi-Cal
  • Managed care contract knowledge
  • ICD-9 coding
  • CPT and HCPCS coding
  • HIPAA compliance
  • Medical billing software
  • Strong planning skills
  • Strong work ethic
  • Team player with positive attitude
  • Deadline-driven
  • Superior written communication
  • Exercises good judgment
  • Billing Adjustments and Refunds
  • Safe Deposit Box Oversight
  • Policy and Procedure Adherence
  • Investigate Claims
  • Invoice Preparation and Processing
  • Customer Feedback
  • Calm and Professional Under Pressure
  • Order Accuracy
  • Maintaining Clean Work Areas
  • Corrective Actions
  • Customer Transactions
  • Livechat Messaging
  • Consultations and Recommendations
  • Training Junior Team Members
  • Merchandise Orders and Exchanges
  • Document and Records Management
  • Customer Retention Strategies
  • Administrative and Office Support
  • Customer Account Management
  • Customer Service and Assistance
  • Microsoft Office
  • Enrollment Processing
  • Clerical Support
  • Product and Service Understanding
  • Training Classes
  • Membership Inquiries and Renewals
  • Process Transactions

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote

There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins

Timeline

Service Specialist II Executive Resolution

WayFair
08.2019 - Current

Delivery Driver

Amazon Delivery Team
04.2019 - 08.2019

Rental Sales Associate

Avis
07.2018 - 01.2019

Billing Specialist

Herron Consulting Services LLC, Herron, Services LLC
02.2011 - 01.2018

Tier 2 Claims Specialist

United Healthcare, UHC
11.2010 - 04.2019

Inbound call center (Manager

Enterprise Rent-A-Car
05.2006 - 05.2011

East St Louis Sr. High

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Keelon JamesFraud Specialist II Executive Resolution