Kierra Reliford
Mckinney
Summary
Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results.
Overview
15
15
years of professional experience
Work History
Reimbursement Case Manager
CareMetx
11.2024 - 03.2025
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
- Maintained patient confidentiality by adhering to strict HIPAA guidelines when handling sensitive information.
- Ensured timely payment of claims by promptly addressing and resolving any discrepancies or issues with insurance providers.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
Customer Support Specialist (Remote)
CVS Health
10.2019 - 06.2024
- Responding to customer queries in a timely and accurate way, via phone, email or chat
- Identifying customer needs and helping customers use specific features
- Analyzing and reporting product malfunctions
- Update our internal databases with information about technical issues and useful discussions with customers
- Monitor customer complaints on social media and reach out to aid
- Share feature requests and effective workarounds with team members
- Inform customers about new features and functionalities
- Follow up with customers to ensure their technical issues are resolved
- Gather customer feedback and share with our Product, Sales and Marketing teams
- Assist in training junior Customer Support Representatives
- Work independently, honor commitments to our members, and collaborate with team members to create a remarkable member experience
Administrative Assistant
Sedgwick
05.2018 - 08.2019
- Produces correspondence, reports, and other documentation; files documents, maintains and tracks suspense file, photocopies, sends and receives facsimile transmissions, etc
- Provides back-up telephone support
- Processes invoices and billings; maintains records and maintains unit attendance records
- Makes travel arrangements
- Maintains adequate supply inventory; orders supply as needed
- Performs other duties as assigned
- Supports the organization's quality program(s)
Customer Service Representative
Blue Cross Blue Shield AL
12.2016 - 05.2018
- Manage incoming calls, faxes and ePAs related to pharmacy prior authorizations
- Refers cases requiring clinical review to a pharmacist or Medical Director
- Responsible for the identification and data entry of pharmacy prior authorization requests
- Analyzes problems and provides information/solutions
- Conducts clinical screening process
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Operates a PC/image station to obtain and extract information, documents information, activities and changes in the database
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Researches and analyzes data to address operational challenges and customer service issues
- Provides external and internal customers with requested information
- Under immediate supervision, receives and places follow-up telephone calls / e-mails to answer customer questions that are routine in nature
Customer Service Rep/Patient Advocate
Express Scripts
08.2014 - 11.2016
- Handle inbound and outbound member, provider and physician calls
- Answer questions related to pharmacy benefits, while maintaining productivity standards and performance guarantees where applicable
- Work with other operational departments to research and resolve mail order and claims issues and respond to members within performance agreement guidelines
- Maintain accurate and complete documentation of all inquiries in order to continuously improve the customer service process and reduce potential legal concerns
- Identify and escalate in a prudent manner, concerns received from patients and/or clients so that corrective action can be pursued and expedited to take care of their needs
- Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety
- Other duties as needed
Front Office Clerk
Christ Community Clinic
07.2011 - 06.2014
- Greet and welcome guests
- Answer questions and address complaints
- Receive letters, packages etc
- And distribute them
- Answer all incoming calls and redirect them or keep messages
- Check, sort and forward emails
Retail Customer Service Associate
Macy's Clothing Store
08.2010 - 05.2011
- Open and close cash registers, performing tasks such as counting money, separating charge slips, coupons, and vouchers, balancing cash drawers, and making deposits
- Maintain knowledge of current sales and promotions, policies regarding payment and exchanges, and security practices
- Recommend, select, and help locate or obtain merchandise based on customer needs and desires
- Answer questions regarding the store and its merchandise
Education
Medical - Sonogram Tech
Collin College
High School Diploma -
KIRBY HIGH SCHOOL
05.2011
Skills
- Real-Time Data Entry
- Problem-solving abilities
- Customer Service
- Microsoft PowerApps
- Organization and multitasking
- Conflict resolution
- Positive attitude
Education
true
Timeline
Reimbursement Case Manager
CareMetx
11.2024 - 03.2025
Customer Support Specialist (Remote)
CVS Health
10.2019 - 06.2024
Administrative Assistant
Sedgwick
05.2018 - 08.2019
Customer Service Representative
Blue Cross Blue Shield AL
12.2016 - 05.2018
Customer Service Rep/Patient Advocate
Express Scripts
08.2014 - 11.2016
Front Office Clerk
Christ Community Clinic
07.2011 - 06.2014
Retail Customer Service Associate
Macy's Clothing Store
08.2010 - 05.2011
High School Diploma -
KIRBY HIGH SCHOOL
Medical - Sonogram Tech
Collin College
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