Kiara Bouzi
Miramar,United States
Summary
Dedicated Customer Service Specialist with over 4 years of experience providing exceptional support and resolving customer issues in fast-paced environments. Known for strong interpersonal skills, effective problem-solving abilities, and a proven track record of enhancing customer satisfaction and retention. Skilled in handling inquiries, managing complaints, claims and delivering solutions with a positive attitude. Seeking to leverage expertise in customer relations and service excellence to contribute to delivering outstanding customer experiences.
Overview
2
2
years of professional experience
Work History
Member Services Representative
Clear spring health
Miramar, United States
02.2024 - 08.2024
- Daily tasks include ongoing incoming and outgoing phone calls; ongoing incoming and outgoing email; ongoing use of member database and members' electronic medical records; processing paper mail; and processing faxes
- Respond to and answer all member and provider inquiries in a courteous, responsive, and timely manner following all departmental and organizational policies and procedures
- Use call tracking systems to document communication with members and providers
- Work collaboratively with providers and members to ensure effective customer service and issue resolution
- Arrange interpretation services for members as needed
- Respond and assist members with Primary Care Provider (PCP) assignments
- Outreach to members regarding benefits and eligibility requirements
- Coordinate mailing of member materials as needed.
Claims Representative
Generali Global Assistance
Pembroke Pines, United States
05.2023 - 11.2023
- Process all claims assigned in a timely, efficient, and accurate manner ensuring that all appropriate policies, procedures, and standard best practices are being followed
- Review information on claim forms, Physician Statements, and other documentation to ascertain completeness and validity of claims
- Correspond with insureds, physicians, agents, and other appropriate parties to obtain proper documentation and to finalize claims
- Maintain proper reserves on each claim file
- Ensure that proper file documentation is collected and maintained, including all records of correspondence and telephone conversations
- Investigate claims and direct the activities of outside adjusters and investigators
- Issue denial of benefits letters when appropriate
- Process attorney represented claims files
- Review and respond to Department of Insurance complaint letters
- Respond to written and phone inquiries regarding claims status
- Issue payments in a timely and accurate manner
- Ensure that current Federal and State insurance claims regulations, laws, and best practices are being employed consistently for all jurisdictions.
Customer Service Representative
Nations benefits CX united healthcare
Miramar, United States
10.2022 - 04.2023
- Daily tasks include ongoing incoming and outgoing phone calls; ongoing incoming and outgoing email; ongoing use of member database and members' electronic medical records; processing paper mail; and processing faxes
- Respond to and answer all member and provider inquiries in a courteous, responsive, and timely manner following all departmental and organizational policies and procedures
- Use call tracking systems to document communication with members and providers
- Work collaboratively with providers and members to ensure effective customer service and issue resolution
- Arrange interpretation services for members as needed
- Respond and assist members with Primary Care Provider (PCP) assignments
- Outreach to members regarding benefits and eligibility requirements
- Coordinate mailing of member materials as needed.
Education
High School Diploma -
MIRAMAR HIGH SCHOOL
Miramar06-2021
Skills
- Communication Skills
- Microsoft Office
- Computer Skills
- Medical Terminology
- Customer Service
- Microsoft Windows
- Typing
- Claims
- HIPAA
- Customer Support
- Issue Resolution
- Member retention
- Insurance knowledge
- Healthcare knowledge
- Complaint Handling
- Policy understanding
Languages
English
Timeline
Member Services Representative
Clear spring health
02.2024 - 08.2024
Claims Representative
Generali Global Assistance
05.2023 - 11.2023
Customer Service Representative
Nations benefits CX united healthcare
10.2022 - 04.2023
High School Diploma -
MIRAMAR HIGH SCHOOL
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