Summary
Overview
Work History
Education
Skills
Timeline
Generic

Krystal Sturgis

Southfield,MI

Summary

Seeking Employment to apply and improve the skills learned in previous positions. Goal is to obtain a career within a company to provide professionalism, growth, and advancement. Able to work hard and challenge myself to learn and explore opportunities to continue to grow and be an asset within the company.

Overview

10
10
years of professional experience

Work History

Complex Issue Resolution Advocate

Blue Care Network Advantage
10.2022 - Current
  • Engage with members to understand complex issues and specific needs by initiating outbound interaction with member based on member data. Develop member trust by proactively listening, interpreting member concerns, and by initiating follow up with member to provide updates on concerns.
  • Conduct internal and external research to determine root cause and appropriate resolution.
  • Engage with internal and external stakeholders to understand and fully remediate the member issue.
  • Support inbound and outbound calls as needed to communicate system issue impacts and resolution to members/providers.
  • Educate members using outbound call campaigns as determined by departmental and corporate initiatives.
  • Use emerging and specialized technologies to increase member engagement using internal and external dashboards to provide personalized solutions and information to members in partnership with care management and group specific initiatives (including broader group/non-healthcare group benefits).
  • Receive and respond to escalated CSR calls and executive escalations.
  • May assist less experienced CSRs and handle unusual and complex inquires, including irate calls as well as those inquiries that may have implications for retention of group, member or provider.
  • Evaluates data and service improvement opportunities, while acting as an information resource and advisor to members.

Interim Unit Lead

Blue Care Network Advantage
05.2022 - 10.2022
  • Evaluates and complete simple adjustments for claim resolution
  • Interacts with internal or external business partners to resolve the inquiry/claim-related problems
  • Provides aid and support to staff handing irate and complex issue resolution
  • Interprets various policies and procedures and makes decisions necessary to the resolution of claims/inquiry
  • Analyzes data and resolves problems related to inquiries and claims processing
  • Knowledge of policies, practices and procedures related to billing, or contract coverage or changes, or rating and eligibility requirements or claims processing.

Member and Provider Representative II

Blue Care Network Advantage
06.2021 - 05.2022
  • Investigated, processed and resolved member, provider, or agent inquiries received via telephone or written correspondence regarding benefits, eligibility, material forms, ID cards, PCP changes, claims, complex inquiries and quality of care issues
  • Educated new and existing members, providers, or agents concerning BCN Advantage policies, procedures, and benefits through daily telephone inquiries
  • Documented each contact through BCNs customer tracking/imaging/workflow system
  • Documented pertinent facts regarding inquiries and update appropriate files
  • Updated membership information following BCN Advantage member services guidelines
  • Maintained positive relationships and interactions with employees, enrolled members, potential members, providers, employer groups, and vendors

Optometric Technician

Henry Ford Optimeyes
09.2018 - 01.2021
  • Perform visual preliminary testing to include auto refraction
  • Inner-ocular pressure, neutralizing prescription eyewear, blood
  • Pressure, visual acuity, motility testing, pupil assessment
  • Confrontation fields, anterior chamber angle assessment, dilation
  • But not limited to these skill sets
  • Documentation recorded into the electronic medical record:
  • Preliminary testing entries and patient chief complaint, medical
  • History, medications, and social history, previous/current contact
  • Lens and eyewear prescriptions, but not limited to these entries
  • Escort patient throughout the exam process and transfer authority
  • To appropriate department
  • Interpret a doctor’s prescription and suggest products and
  • Enhancements to address specific prescription requirements

CSR Lead

Henry Ford Optimeyes
01.2017 - 09.2018
  • Schedule appointment
  • Verify insurance benefits
  • Assist with customer and team complaint
  • Manage and train team members on serval customer service skills from communication daily job duties.

Customer Service Advocate

AAA
04.2013 - 01.2017
  • Receive various incoming calls from members daily
  • Accept service request for upcoming auto traveling
  • Sale and service memberships; payments, upgrades and reinstatements
  • Dispatch road service

Education

Bachelor of Science - Accounting And Business Management

Wayne State University
Detroit, MI
12.2023

High School Diploma -

Oak Park High School
Oak Park, MI
06.2008

Skills

  • Proficient in Microsoft Office
  • Problem-Solving
  • Leadership Skills
  • Active Listening
  • Customer Service
  • Training Materials

Timeline

Complex Issue Resolution Advocate

Blue Care Network Advantage
10.2022 - Current

Interim Unit Lead

Blue Care Network Advantage
05.2022 - 10.2022

Member and Provider Representative II

Blue Care Network Advantage
06.2021 - 05.2022

Optometric Technician

Henry Ford Optimeyes
09.2018 - 01.2021

CSR Lead

Henry Ford Optimeyes
01.2017 - 09.2018

Customer Service Advocate

AAA
04.2013 - 01.2017

Bachelor of Science - Accounting And Business Management

Wayne State University

High School Diploma -

Oak Park High School

Similar Profiles

CREATE PROFILE
Krystal Sturgis