Krisha Richey
Sacramento,CA
Summary
Dynamic Customer Service Representative Specialist with over 18 years of experience in efficiently processing customer inquiries, complaints, and issues in compliance with state and federal regulations. Proven track record in documenting interactions to ensure regulatory adherence while supporting investigations to identify root causes and implement effective resolutions. Strong collaborator with internal stakeholders, committed to delivering timely and quality responses that uphold confidentiality and enhance customer satisfaction. Focused on driving brand awareness, engagement, and conversion rates while consistently exceeding company goals through exceptional service delivery.
Overview
19
19
years of professional experience
Work History
Customer Service Representative
Health Net
07.2007 - Current
- Resolved customer inquiries and issues through effective communication and problem-solving techniques.
- Educated clients on healthcare plans, benefits, and coverage options to enhance understanding.
- Collaborated with cross-functional teams to streamline service processes and improve customer satisfaction.
- Maintained accurate records of customer interactions using CRM systems for efficient follow-up.
Customer Service Representative
Health Net
01.2007 - Current
- Serviced escalated inbound ACD calls, related to all aspects of service for members and providers. Effectively communicates, written and verbally, the Health Net policies, procedures. Handle difficult and sensitive issues appropriately, maintaining QA of 95% or higher level of customer. Provide benefits to members or providers. Travel to other Health Net call centers to help with training. Conduct shoulder tap with new procedures. Research claims, medical and pharmacy authorization. Collaborate with other departments on cross functional tasks and projects Maintain performance and quality standards based on established call center metrics including turnaround times. Assisting Teleperformance reps, members and providers in all enquiries regarding plan benefits, eligibility, billing, prior authorization, enrollment and problem resolution. Strong ability to prioritize issues, strong sense of urgency and task to ensure that timelines and goals are met while ensuring efficiency and quality. Assisting providers with claims and claims reprocessing. Take supervisor calls, Escalate claims, Floor support, Quality Assurance -listen to rep calls, Process premium payments, Part of Travel team. Achieved
Quality Assurance score of -95% or higher
Education
High School Diploma -
John F. Kennedy
Sacramento, CA06-1990
Skills
- Prime
- Omni
- Trucare
- Filenet
- Amisys
- Maces
- Payspan
- Portico
Timeline
Customer Service Representative
Health Net
07.2007 - Current
Customer Service Representative
Health Net
01.2007 - Current
High School Diploma -
John F. Kennedy
PRODUCTS
- Medicare
- Medi-cal
- ACA on/off exchange
- Medicare Supplemental
- Commercial