KELSEY RIGGS
Timmonsville,SC
Summary
Accomplished healthcare support professional with a proven track record in insurance claims, patient engagement, and remote customer service. Demonstrates expertise in resolving intricate issues, delivering compassionate support, and ensuring precise and prompt claims processing. Recognized for adeptly managing multiple tasks in fast-paced settings, upholding HIPAA compliance standards, and delivering top-notch service excellence.
Overview
9
9
years of professional experience
Work History
Patient Care Coordinator
Assurant
01.2021 - Current
- Organized patient records and database to facilitate information storage and retrieval.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Compiled and maintained patient medical records to keep information complete and up-to-date.
- Provided excellent customer service to patients and medical staff.
- Facilitated communication between patients and various departments and staff.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
- Facilitated communication between patients and healthcare teams, ensuring clarity and understanding of treatment options.
- Improved patient care outcomes with meticulous follow-up on treatment plans and medications.
- Advocated for patients' rights and needs, ensuring their voices were heard in care decisions.
Customer Service Team Lead – Healthcare Account
Sykes Enterprises
01.2019 - 01.2021
- Conducted performance evaluations, providing constructive feedback to foster professional growth among team members.
- Led customer service team to achieve high satisfaction ratings through effective coaching and support.
- Resolved complex customer issues by analyzing data and collaborating with cross-functional teams for solutions.
- Monitored team performance metrics, ensuring adherence to quality assurance protocols and service level agreements.
- Supported representatives in navigating difficult interactions with customers, offering guidance on appropriate de-escalation techniques when needed.
- Addressed escalated customer concerns promptly, ensuring satisfactory resolutions while preserving long-term relationships.
- Served as a resource for representatives, answering questions and providing guidance on best practices in addressing specific customer concerns.
- Assisted management in hiring decisions by conducting interviews with prospective candidates and evaluating their suitability for the Customer Service Team Lead role effectively.
Medical Claims Representative
Blue Cross Blue Shield of South Carolina
01.2017 - 07.2019
- Reviewed claim documentation for accuracy, identifying discrepancies and initiating corrections as needed.
- Processed medical claims, ensuring adherence to company policies and regulatory guidelines.
- Communicated with healthcare providers and members to resolve claim-related inquiries efficiently.
- Assisted in training new team members on claims processing protocols and best practices.
- Handled complex claim issues, effectively communicating with patients, providers, and insurance companies to ensure resolution.
- Maintained up-to-date knowledge of industry regulations impacting claims processing procedures.
- Secured proper payment for services rendered by thoroughly reviewing insurance coverages and applying appropriate codes.
Education
Associate Of Applied Science - Health Sciences
Williamsburg Technical College
Kingstree, SC01.2022
High School Diploma -
Lake City High School
Lake City, SC01.2014
Skills
- Medical & Insurance Claims Processing
- Medicaid, VA, and Commercial Insurance Knowledge
- HIPAA Compliance & Patient Confidentiality
- CRM Systems: Salesforce, Zendesk, Genesys
- Microsoft Office Suite & Remote Work Tools
- Conflict Resolution
- Active Listening
- Empathy-Based Communication
Timeline
Patient Care Coordinator
Assurant
01.2021 - Current
Customer Service Team Lead – Healthcare Account
Sykes Enterprises
01.2019 - 01.2021
Medical Claims Representative
Blue Cross Blue Shield of South Carolina
01.2017 - 07.2019
Associate Of Applied Science - Health Sciences
Williamsburg Technical College
High School Diploma -
Lake City High School