Kristy Groves
Bentonville,AR
Summary
Results-driven Customer Service Specialist highly skilled in account management and sales techniques. Bringing 25 years of experience in professional communication with customers and peers. Skilled communicator known for contributing to repeat business. Seasoned insurance specialist with excellent planning and problem solving abilities. Offering several years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.
Overview
16
16
years of professional experience
Work History
Group Member Services
TTEC - Blue Cross Blue Sheild
Bentonville, AR
12.2021 - Current
- Assisted with customer inquiries, complaints, and requests for information regarding insurance policies.
- Evaluated insurance claims to ensure accuracy and completeness of documents.
- Verified insurance coverage and eligibility for services provided.
- Researched policy provisions to determine coverage levels, limitations, and exclusions.
- Applied knowledge of coding systems such as ICD-10, CPT, and HCPCS to accurately process claims.
- Maintained accurate documentation of all activities related to claim adjudication.
- Provided education and guidance on appeal rights when a claim is denied or partially paid.
- Reconciled discrepancies between the Explanation of Benefits statement and the submitted claim form.
- Collaborated with other departments within the organization in order to resolve issues quickly.
- Communicated decisions about claims via phone or written correspondence with providers.
- Attended continuing education seminars related to changes in laws or regulations governing health insurance policies.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
Customer Service Associate
Ocean Canyon Properties
Texarkana, TX
09.2019 - 02.2020
- Offering the best customer support possible and helping resolve any issues the customer is having while reassuring them that I will find a resolution for them.
- Taking calls to resolve software issues for Apple.
- Moved up to senior advisor within three months.
- Using customer service skills to calm customers and ensure they are happy at the end of the call.
- Researching issues while not on calls to find solutions to difficult problems.
- Setting up call backs for my cases to ensure issue is resolved.
- Continuation training on Apple products.
- Trained in Mac+ on Apple watches and iPhone software.
- Mentored new advisors and helped train.
- Maintained above average numbers.
Merchandiser
Winston Retail
10.2017 - 10.2018
- Merchandising brand representative for Texas district I am responsible for many different brands including but not limited to Carhartt, Adidas, Nespresso and Under Armor.
- Always adhering to each to each retailors policies and procedures.
- Maintaining a positive relationship with each retailors management team to drive business results.
- Creating a positive rapport with all associates and management.
- Ensuring there is concise and professional communication with each store manager.
- Gathering information that can support the visual and sales success of each brand.
- Executing multiple different brand merchandising set and striving for excellence.
- Knowledgeable on many different brand and merchandising requirements as well as store floor set expectations.
- Extensive training on each brand and ensuring training is done in a timely manner.
- Assisting managers with customer relations to better sale a verity of brands.
- Reviewing and submitting mPlans in a professional dialogue to submit for review.
- Submitting before and after pictures of floor sets to ensure visual standards meet expectations.
- Discussing with each stores management team different sales techniques and products to enhance sales in their individual stores.
- Assisting customers while at each store to help with the training of associates on brand specifics.
Manager
Alliance Advisors
04.2017 - 10.2018
- Responsibilities include being able to speak professionally with shareholders to explain proposals at upcoming stockholder meetings.
- Required to have high speed internet, headset and printer.
- Be able to work from home without needing much direction.
- Being knowledgeable about each client's upcoming meeting dates and the proposals that are up for shareholder vote so that I can explain them to shareholders in a way they understand.
- Dealing with upset shareholders in a professional way to calm them down and persuade them to cast a vote.
- Being able to quickly disposition calls in order to reach as many shareholders as possible.
- Being able to work from home without distractions and multitasking when necessary.
Convergys-Harry and David
11.2017 - 02.2018
- Responsibilities includes being able to work with customers from home while still offering a professional work environment.
- Achieve specific sales target to maximize sales opportunities on each call.
- Use script/or probing techniques to determine customer needs and offer the most appropriate product or service available.
- Maintain broad knowledge of products, pricing, promotions and procedures.
- Ensure service delivered to customers meets contractual sales goals and other Key performance indicators (KPI).
- Prepare complete and accurate work including appropriately notating accounts as required.
- Participate in activities designed to improve customer satisfaction and sales performance.
- Answer billing questions by talking through components of customer accounts.
Gregg Orr Auto-Sales Associate
07.2015 - 02.2016
- Main responsibilities included being knowledgeable on all makes and models of vehicles.
- Working with customers to find the right vehicle for them or their family.
- Building a client base and making sure I went out to local businesses or community events to get my name out to the public to draw customer's in.
- Apprise car shoppers of warranties and financing options.
- Showing cars to people who visit the dealership and explaining the characteristic of various.
- Well informed about all the cars he/she is selling and be ready to answer questions about gas usability and engine size, mileage, and colors that each model comes in.
- Being able to use my persuasive skills to close car deals.
- Helping find the best finance options for each client.
Store Manager
Children's Place
06.2012 - 05.2015
- Main responsibility is to successfully run the million dollar a year business.
- We are now one of the top three in the district on percent to LY sales and percent to plan because of the hands on and active approach I take with my associates.
- Maintaining a high level of communication with all my assistance in order to stay on the same page when performing a task or when dealing with customers and associates.
- Ensuring all LP measures are being done on a daily basis.
- Overall loss has been cut in half during my tenure this was achieved solely by following the proper procedures.
- As a member of the District Talent team, I handle all in store training and one of my additional responsibilities is delegating company training techniques to the rest of the managers in my district and provide them with any new training tools.
- I've been able to promote from with-in my store and have most open positions filled within 30 days.
- Manage all payroll and have never gone over on hours and have saved the company 20% in payroll last year.
- Motivating my team to achieve even higher results for this year.
- We received many rewards and awards the last few Quarters.
- Setting goals for each team member making sure to follow up whether its for accomplishing the task or to give further directions in a positive manner.
- Responsible for all quarterly and yearly reviews with associate so they are aware of what the expectations are and set a plan in place in order to exceed those expectations.
- Analyzing weekly, monthly and yearly paperwork so that I could determine the needs of my business so that I could make quick changes to areas where we may have been lacking.
Smashburger - General Manager
04.2011 - 07.2012
- Main responsibility was to run a successful business day to day.
- Everything that was ordered or came in had to be approved by me and I had to make sure I was making the best decisions for the business.
- Ensuring all staffing needs were met.
- Motivating my team to perform at the highest standards possible.
- Overseeing and making necessary changes during work hours and handling any complaints professionally be it customer or Internal.
- Financial planning for the month each month keeping the store under budget by making smart choices when placing truck orders, supply orders and payroll.
- Placed all truck orders and kept detailed files on what was on the truck ensuring nothing was left out.
- Did all hiring and training placement and set goals for my Managers to help keep them on track.
- Did all Performance Reviews and write-ups and if needed I did all the terminating of employees.
- Handling each with extreme care and making sure I retrieved all company property back after termination and everything was handled in a professional manner.
- Made sure all food was prepared to specific guidelines to ensure the store served and stored food according to state guidelines.
- Analyzing business on a daily and sometimes hourly basis to make adjustments to fit our customers needs.
Aeropostale Merchandising Manager
06.2010 - 04.2011
- Ensuring visual standards throughout store maintaining Brand standards throughout and ensured my associates were trained well on what those standards were.
- Actively involved with customers so that we could meet all sales goals and also teaching by example.
- Made sure proper plans and schedules were prepared in order to get major sets done in a timely manner.
- Interviewing new hires and making sure we brought in the right talent for our store.
- Training new hires on sales techniques and Brand presentation.
- Ensuring all Opening and closing duties were completed correctly and all money was accounted for.
- Maintained payroll keeping under budget.
- Analyzing the business from various different indicators to ensure we were making the proper adjustments to run a more successful business.
Assistant Manager
Pacific Sunwear
01.2009 - 06.2010
- Ensuring visual standards throughout store maintaining Brand standards throughout and ensured my associates were trained well on what those standards were.
- Actively involved with customers so that we could meet all sales goals and also teaching by example.
- Made sure proper plans and schedules were prepared in order to get major sets done in a timely manner.
- Interviewing new hires and making sure we brought in the right talent for our store.
- Training new hires on sales techniques and Brand presentation.
- Ensuring all Opening and closing duties were completed correctly and all money was accounted for.
- Maintained payroll keeping under budget.
- Analyzing the business from various different indicators to ensure we were making the proper adjustments to run a more successful business.
Education
Business Administration
Texarkana College
Skills
- Call Centers
- Data evaluation
- CRM
- Conflict mediation
- Customer relations
- Customer Service
- Project management
- Problem Resolution
- Senior leadership support
- Credit card payment processing
- Microsoft Office expertise
- System implementation
- Business development understanding
- Retail sales customer service
- Shipping and receiving understanding
- Sales expertise
- Quality assurance controls
- Store maintenance
- Inbound and Outbound Calling
- High-energy attitude
- Technologically savvy
- Claims Handling
- Data Interpretation
- HIPAA Compliance
Timeline
Group Member Services
TTEC - Blue Cross Blue Sheild
12.2021 - Current
Customer Service Associate
Ocean Canyon Properties
09.2019 - 02.2020
Convergys-Harry and David
11.2017 - 02.2018
Merchandiser
Winston Retail
10.2017 - 10.2018
Manager
Alliance Advisors
04.2017 - 10.2018
Gregg Orr Auto-Sales Associate
07.2015 - 02.2016
Store Manager
Children's Place
06.2012 - 05.2015
Smashburger - General Manager
04.2011 - 07.2012
Aeropostale Merchandising Manager
06.2010 - 04.2011
Assistant Manager
Pacific Sunwear
01.2009 - 06.2010
Business Administration
Texarkana College
Similar Profiles
Samson OwingsSamson Owings
Associate System Engineer at Blue Cross BLue Sheild Of North DakotaAssociate System Engineer at Blue Cross BLue Sheild Of North Dakota
Vashty BrownVashty Brown
Customer Care Representative at Blue Cross And Blue Sheild Of North CarolinaCustomer Care Representative at Blue Cross And Blue Sheild Of North Carolina
Doris LohmanDoris Lohman
Nurse Care Manager at Blue Cross Blue Sheild of MichiganNurse Care Manager at Blue Cross Blue Sheild of Michigan