Kenisha Milton
Jacksonville,FL
Summary
Dynamic and results-driven professional with extensive experience at Amerihealth Caritas, excelling in customer service and problem resolution. Recognized as a Subject Matter Expert, I effectively train teams and enhance operational efficiency. Proficient in Microsoft Excel, I leverage data analysis to drive performance goals and ensure timely claim resolutions.
Overview
94
94
years of professional experience
Work History
Provider Claim Services Rep
Amerihealth Caritas
Jacksonville, FL
03.2020 - Current
- Suspends claim inquiring additional information and/or special handling; initiates action to obtain required information
- Forwards claims requiring external department intervention to the appropriate department
- Monitors outstanding inquiries and works with management staff to identify and resolve of non-compliance
- Review and verify quality audit reports
- Reconciles audit discrepancies, corrects in system and make appropriate to avoid recurrence
- Maintains thorough knowledge of claim process system, its databases and subsystems
- Responds to and resolve provider and health plan claim inquiries
- Monitors and track aged, pended and open reports to maintain timeliness in claims
- Documents file, as appropriate to support payment decision
- Conducts cross training to staff as required
- Subject Matter Expert(SME) for the Provider Claims Services new hires
Customer Service Representative
Contemporary Staffing-Ally Financial
01.2016 - 01.2107
- Fulfillment Department (PIF)
Member/Provider Services Rep
Amerihealth Caritas
Jacksonville, FL
07.2017 - 02.2020
- Responsible for responding to a diverse membership and their providers as well as customers in a timely, professional manner
- Receive inbound member and provider calls regarding benefit, eligibility or customer issues.
- Provide member education and assist with finding in network provider, PCP selection and assignment
- Follows internal processes and procedures to ensure all activities are performed in accordance with departmental and company policies and procedures.
- Maintain records of member/provider interactions, detail of inquiries, complaints or comments and take action when needed.
- Assisted providers with general claim status and information.
- Subject Matter Expert for Member Services new hires
Customer Account Executive-Retention
Comcast
01.2014 - 01.2016
- Listen attentively to customer needs and concerns; demonstrate empathy
- Up-sell and suggestive sales on every call
- Meet customer requirements through first contact resolution
- Confirm customer understanding of the solution and provide additional customer education as needed
- Offer solutions to issues that are often non-standard/non-routine and require some clarification
- Maintain broad knowledge of client products and services
Customer Service Representative
Convergys
01.2013 - 01.2014
- Prepare complete and accurate work and update customer file
- Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of customer requests
- Effectively transfer misdirected customer requests to an appropriate party
- Contribute ideas on ways to resolve problems to better serve the customer and/or improve productivity
- Participate in activities designed to improve customer satisfaction and business performance
- Occasionally use decision-support tools to answer questions
- Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking
- Offer solutions to issues that are often non-standard/non-routine and require some clarification
- Maintain broad knowledge of client products and services.
Education
Diploma -
Wolfson Senior High School
01.1996
Skills
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Facets
- Customer Service Skills
- Subject Matter Expert
- Cross training
- Problem resolution
- Effective communication
- Time management
- Team collaboration
- Customer service
- Data entry
- Multitasking and organization
- Performance goals
- Tech-Savvy
Timeline
Provider Claim Services Rep
Amerihealth Caritas
03.2020 - Current
Member/Provider Services Rep
Amerihealth Caritas
07.2017 - 02.2020
Customer Service Representative
Contemporary Staffing-Ally Financial
01.2016 - 01.2107
Customer Account Executive-Retention
Comcast
01.2014 - 01.2016
Customer Service Representative
Convergys
01.2013 - 01.2014
Diploma -
Wolfson Senior High School
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