Summary
Overview
Work History
Education
Skills
Timeline
BusinessAnalyst

Kelly Thompson

Member Service Claims Rep
Rancho Cucamonga,CA

Summary

Providing insurance services to clients over the course of ten years, including Auto, Property, Medical, and Accounting services. A proven record of exceptional accomplishments in the areas of customer relations and support within a call center environment. Passionate about increasing customer engagement and building strong customer relationships. Exceptional organizational skills and professional work ethic. Organized and dependable at managing multiple priorities with a high degree of accuracy and a positive attitude. Highly effective working with stressed and upset individuals in need of information and supportive guidance when navigating the claim process. Willingness to take on added responsibilities in support of company and team goals.

Overview

10
10
years of professional experience

Work History

Member Services Representative

Inland Empire Health Plan
09.2021 - 07.2022

Delivered exceptional customer service by leveraging extensive knowledge of Medi-Cal products and services and creating welcoming, positive experiences.

  • Demonstrated empathy when addressing customer concerns, while maintaining friendly, professional customer interactions and resolving problems effectively.
  • Provided guidance and education regarding health plan coverage, authorizations, referrals and claims.
  • Assisted members with using helpful decision-making tools on IEHP website regarding complex matters related to their wellbeing.
  • Managed over 50+ calls per day.
  • Responded to customer requests, via email and phone, offering excellent support and tailored recommendations to address needs.
  • Collaborate with inter-departments staff members to enhance customer service experience, ensuring member needs are addressed appropriately with regards to Behavioral Health, Pharmacy and Interpreter services.
  • Exceeded guidelines for call handle time, service levels, and productivity on daily basis.
  • Exhibited high energy and professionalism when dealing with members and staff.
  • Exceeded team goals verified through client satisfaction survey results.
  • Continuously sought ways to improve processes and services provided

Warehouse Associate

Amazon
06.2019 - 12.2019

Frequently worked in fast-paced, physical team environment.

  • Ensured accuracy, quality and quantity of materials received and listed in computer system.
  • Picked, packed, and loaded orders onto conveyor belts for shipment.
  • Using RF scanner guns, sort items into containers and place them on conveyors with high level of accuracy.
  • Operated pallet jacks and material moving equipment to transport items from various locations throughout warehouse.
  • Inspected work areas for cleanliness and obstacles and removed cartons and boxes to keep work areas organized and hazard-free.
  • Consistently lifted materials weighing as much as 50 pounds
  • Worked safely around moving machinery

Primary Caregiver for Elderly Parents

My Resident-home
07.2014 - 03.2019

Provided full-time care to aging parents.

  • Maintained clean, safe, and well-organized environment.
  • Cleaned house, ran errands, managed laundry, and completed weekly grocery shopping.
  • Administered medications following prescribed instructions to alleviate symptoms and discomfort, monitored reactions.
  • Maintained entire family's schedule and organized events.
  • Handled incoming mail, bills and completed appropriate actions.
  • Provided safe mobility support to help move around personal and public spaces.
  • In order to maintain professional and computer skills, took online computer courses on regular basis.

Customer Care Specialist Tier II

AppleOne - Legal Zoom
03.2014 - 07.2014
  • Responded to customer inquiries via phone, email and web-based platforms regarding products and services.
  • Managed over 60 customer calls per day.
  • Communicated with customers to assess and address individual needs, and expectations of companies products and services.
  • Provided customers with detailed information on company products and services from perspective of customers' particular requirements.
  • Prior to transferring customers to appropriate departments, updated and documented essential data to prevent redundancies and delays.
  • Build strong knowledge of products DBA's, LLC's, Corporations and S Corporations services to better serve customers in selecting products to meet their individual business needs.
  • Documented all customer interactions via system database.
  • Followed up with customers on unresolved issues and concerns.
  • Utilized customer feedback to identify sales opportunities and optimize customer satisfaction.

Claims Service Specialist

Allstate Insurance Company
08.2011 - 01.2014

Worked productively in fast-moving work environment to take high volumes of calls and process claims.

  • Managed over 50+ customer calls per day.
  • Interview policyholders, claimants and attorneys to create accurate loss reports for automotive, property and bodily injury.
  • Obtain facts to evaluate coverage, liability, mechanics, and causation/damages.
  • Assessed and evaluated claims to determine company's liability and to establish appropriate reserves.
  • Handle low to moderately complex cases.
  • Generated, posted and attached information to claim files.
  • Created 'Promise of Payment' and Liability' letters for policyholders, claimants and vendors.
  • Issued payments and reimbursements.
  • Supported Subrogation department with various processes including DMV research, and data input.
  • Maintained strong knowledge of medical terminology to better understand services and procedures.

Client Support Specialist

Automatic Data Processing, Inc, ADP
05.2008 - 06.2011
  • Responded to all client inquiries, asked appropriate questions to facilitate resolution by professionally responding to incoming calls, web inquiries, emails and faxes.
  • Managed over 45 customer calls per day.
  • Support various levels of Payroll and HR clients by providing prompt and thorough responses to service inquiries.
  • Maintain accurate records of client contact through documentation in Access/Clarify system.
  • Confirm receipt of payroll transmission.
  • Resolve payroll input errors by researching and analyzing with test transmissions.
  • Provide online support with instructional navigation.
  • Produce critical and accurate statutory information for time sensitive tax filings.
  • Maintained up-to-date knowledge of product and service changes.

Education

Certificate of Pharmacy Technician - Pharmacy Technology

Everest College - Ontario, CA US
Ontario, CA
06.2013

Skills

  • Auto, Property and Medical Claims
  • Coverage Determination
  • Policy and Claims Process Explanation
  • Authorization Verification
  • Client Correspondence
  • Building Customer Trust and Loyalty while using Active Listening Skills
  • Flexible and Adaptable
  • Comfortable Working Independently
  • Strong Written Communication
  • Analytical and Critical Thinking
  • Professional Telephone Etiquette
  • Proficiency with MS Word, Excel, Outlook, TEAMS, OneNote, OneDrive and PowerPoint
  • Medical Terminology
  • ICD10, HCPCS, CPT

Timeline

Member Services Representative

Inland Empire Health Plan
09.2021 - 07.2022

Warehouse Associate

Amazon
06.2019 - 12.2019

Primary Caregiver for Elderly Parents

My Resident-home
07.2014 - 03.2019

Customer Care Specialist Tier II

AppleOne - Legal Zoom
03.2014 - 07.2014

Claims Service Specialist

Allstate Insurance Company
08.2011 - 01.2014

Client Support Specialist

Automatic Data Processing, Inc, ADP
05.2008 - 06.2011

Certificate of Pharmacy Technician - Pharmacy Technology

Everest College - Ontario, CA US
Kelly ThompsonMember Service Claims Rep