Kristian A Smith

• Educate members on how to best utilize their benefits

• Troubleshoot pharmacy claims real-time to include verifying information the pharmacy submits, comparing the claim result to benefit rules, and entering allowed overrides to allow claims to pay

• Send documents to providers electronically

• Follow up and provide superior service through outbound calls as necessary

• Anticipate and address questions to prevent repeat calls in order to delight customers and reduce customer effort

• Treat all customers with respect and display empathy

• Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements

• Deliver all relevant information timely, clearly communicating in a manner that ensures customer understanding

• Utilize resources consistently to incorporate changes in our fast-paced environment

• Adapt to fluctuations in workload from slower times to extremely busy times

• Effectively work/communicate with internal teams, such as other Customer Care team members, Prior Authorization, Manual Claims

• Maintain scheduled hours and demonstrate flexibility to aid in coverage

• Make accurate determinations about policies and claims by diligently analyzing statements, account records, and other documentation
• Trained in calculating numbers for premiums and reserve requirements
• Demonstrated commitment to company conduct, ethics and compliance policies and procedures and adhered to state and federal regulations
• Provided account information, claims procedure guidance, and additional resources to support policyholders throughout the claims process
• Prepared insurance claim forms, reviewing documents for accuracy and completeness
• Explained policy details, claims status, and account changes to inform policyholders
• Verified personal data on insurance applications and policies
• Navigated multiple computer systems and utilized search tools to find information

• As a Customer Success Specialist, my job consists I play a key role in supporting our customers with Payroll related questions via our Rapid Response hotline
• Provided in-depth analysis and timely resolutions/workarounds for client issues while also handling difficult & sensitive situations, in a professional, timely, and thorough manner
• Answered customer telephone calls promptly to avoid on-hold wait times
• Offered advice and assistance to customers, paying attention to special needs or wants
• Built trusting relationship with customers to better understand needs
• Collaborated across departments to resolve customer-related issues

• Created and entered enrollment applications for new consumers in company database
• Updated records with details of customer interactions and transactions
• Answered phones and resolved customer issues and complaints
• Processed customer transactions according to established policies and procedures
• Gathered and verified required customer information for tracking purposes
• Navigated multiple computer systems and utilized search tools to find information
• Kept records of customer interactions or transactions, recording details of inquiries and actions taken
• Enhanced customer satisfaction with fast, knowledgeable service
• Served as primary point of contact for customer inquiries and questions
• Completed contract forms, prepared change of address records, or issued service discontinuance orders with computer and job-related software

• Answer customers' questions about products, prices, availability, or credit terms
• Prepare sales contracts for orders obtained, and submit orders for processing
• Handled customer inquiries, payments and service requests
• Inform customers of estimated delivery schedules, service contracts, warranties, or other information pertaining to purchased products
• Helped customers complete purchases, locate items and join reward programs to promote loyalty, satisfaction and sales numbers
• Qualifications for this position included good communication, problem-solving, and computer skills (chat, email, inbound phone calls)