KIARA SPENCE
Haines City,FL
Summary
To obtain employment that will allow me to utilize my skill set and experience in a challenging environment that will benefit my employer as well as employment opportunities for job advancement. I am detailed oriented, outgoing, and determined with the ability to learn quickly and rise to all challenges both as a team player and as an individual. I have Over 10 years' experience in the Customer Service industry as well as Medical Billing and Coding with career progression. Proven accomplishments in Customer Service, office management, program planning, project management, policy development and problem resolution
Overview
10
10
years of professional experience
Work History
Customer Success Specialist
Apex Systems/Gusto
Orlando, Florida
12.2023 - Current
- CX Customer Success Specialists will act as either a payroll and benefits specialist or health insurance specialist, providing world-class service to Gusto customers using Gusto to manage both payroll and their health insurance. We are looking for customer service-oriented individuals, who enjoy analyzing various requests in order to facilitate an effective and timely resolution.You will direct customers to product features that will improve their business and allow owners to manage their companies more effectively. You may work with cross-functional Gusto teams to help solve the customer’s inquiry. You may also serve as a liaison between insurance carriers and customers. Most importantly, you will positively influence businesses and employees across the US by guiding customers through your product expertise - Turning daunting business issues into manageable tasks
Customer Service Specialist
AllianceRX Walgreens
Orlando, USA
06.2019 - 10.2023
- Monitored team of 5 Customer Services Representatives to assess knowledge, tone and adherence to company policy
- Trained staff to provide excellent customer service to challenging customers
- Answered customers' questions and addressed complaints in-person or by phone to immediately rectify issues
- Handled escalated queries and complaints from customers and staff, sharing positive outcomes as training tools
- Made outbound calls to obtain and verify account information
- Prepared detailed and comprehensive reports and follow up reports with concise and effective action plans designed
- Ran test claims and Verified patient coverage providing assistance to members and providers regarding programs, policies, eligibility, benefits, claims and authorization of services from members or providers
Pharmacy Clerk
OptumRx
Orlando, USA
01.2018 - 04.2019
- Navigate across multiple computer systems to identify information needed for outbound calls to members/providers
- Make outgoing calls as needed to provide information on prior authorization case outcome, follow-up, or consultation such as prior authorization requirements, appeals, etc
- Educate members/guardians, providers, pharmacy staff on procedures to avoid compliance risk
- Assist in creating /routing pharmacy orders through receipt, review, and verification of members' prescriptions
- Preps and scans documents, verifies member data, submits cases in computer system
- Meet departmental established performance expectations and working independently to complete tasks in a timely manner
- May include processing member prior authorizations through various computer systems ensuring the accuracy of all data and updating, as necessary
- May take incoming calls from members or providers and apply benefit plan criteria in making decisions (approvals / denials) or recommendations; clarify and explain pharmaceutical benefits and procedures
- May partner with others to gather additional information and / or to interpret clinical guidelines, act as a resource for others
FMLA Claims Specialist
Reed Group Ltd
Orlando, USA
06.2015 - 12.2017
- Communicates with employees regarding their needs for leave and/or modified work schedules. Ensures that employees are aware of their responsibilities and of any documentation and notice required to qualify for and to take leave.Handles the FMLA leave administration process from the employees initial notice of the need for leave to the return to work. This includes gathering and completing all required paperwork, determining leave eligibility, designating leave as FMLA-qualifying, requesting medical certification as needed, and accounting for intermittent and reduced schedule leave use.Maintains reasonable communication with employees on leave to facilitate smooth and timely return to work; relays communication between employees and their managers during leave within reason.Advises managers and employees on the interaction of leave laws with paid time off, workers compensation, and short-term and long-term disability benefits.Oversees the return-to-work process for employees returning from extended FMLA, workers compensation, or other leave(s).Facilitates other leave requests, which may include accommodation requests under the ADA.Administers other company time-off programs as assigned in accordance with internal policy and applicable laws.Drafts and/or recommends revisions to company leave policies to ensure compliance with federal, state, and local laws and regulations.Maintains complete and accurate records of leave and accommodation requests in accordance with specified legal requirements and documentation of best practices.Preserves confidentiality of employee medical documentation and files.Maintains knowledge of all applicable leave and accommodation laws including the FMLA, ADA, and state and local laws.Performs other related duties as assigned
Education
Facial Specialist -
Ridge Technical College
Winter Haven, FL10.2022
High School Diploma -
Dr. Phillips High School
Orlando, FL05.2007
Skills
- ▪ HIPAA▪ Exceptional communication▪ Relationship building▪ Customer advocate▪ 6-20 All lines Adjusters License▪ Administrative support▪ Critical thinking▪ Coordinator▪ Treatment Planning▪ Reporting▪ Pharmaceutical▪ Billing▪ Scheduler▪ MS Office Suite▪ Client support▪ Customer Service and TechnicalSupport▪ Short Term Disability Case Manager▪ FMLA/STD/LTD, Worker’s Comp claims▪ New Hire Training▪ Coordinate daily work flow▪ Quality Assurance Audits▪ Compliance of HIPPA Laws, FMLA and ADA Leaves▪ Team Builder▪ Coaching and Development▪ Analytical
Timeline
Customer Success Specialist
Apex Systems/Gusto
12.2023 - Current
Customer Service Specialist
AllianceRX Walgreens
06.2019 - 10.2023
Pharmacy Clerk
OptumRx
01.2018 - 04.2019
FMLA Claims Specialist
Reed Group Ltd
06.2015 - 12.2017
Facial Specialist -
Ridge Technical College
High School Diploma -
Dr. Phillips High School