Customer Advocate with over 10 years of success in customer service, insurance, and claims processing review. Results-oriented and enthusiastic professional with over 15 years of experience in resolving issues, increasing customer satisfaction, and driving operational improvements. Well versed in operational processes and solution-focused to promote successful outcomes. Strong problem-solving, negotiation, and communication skills.
Hi, I’m
Lacol Cleare
Powder Springs,Georgia
Summary
Overview
12
years of professional experience
Work History
Clearechoice Solutions
ADMINISTRATIVE MANAGER
05.2012 - Current
Job overview
- Developed strong relationships with clients through exceptional customer service and timely responses to inquiries.
- Maintained strict confidentiality of sensitive information, upholding the highest standards of professionalism at all times.
- Created a welcoming office environment by maintaining clean, organized spaces for staff use.
- Monitored inventory levels of office supplies, placing orders when necessary to prevent stock shortages.
BCforward/Anthem
TEMPORARY HEALTH PROGRAM REPRESENTATIVE
01.2023 - 08.2023
Job overview
- Provided initial contact between Care Management program and specific identified member conducting engagement calls to provide information regarding program features, values and explaining available services.
Wellstar Health Systems
CUSTOMER SERVICE & COLLECTIONS REPRESENTATIVE
01.2020 - 01.2022
Job overview
- Communicated with customers through various channels acknowledging and resolving complex customer service issues, complaints, disputes, appeals along with general billing concerns
- Processed payments for self pay services, ordering forms, submissions for internal work orders requests, and financial assistance applications
- Responsible for managing collection on all accounts receivable for Wellstar patients along with setting up payment plans or processing payments for various delinquent accounts types by phone, mail, visits in person or online via Wellstar Mychart application.
Caresource
CUSTOMER ADVOCATE: PROVIDER SERVICE REPRESENTATIVE II
01.2017 - 01.2021
Job overview
- Enacted as a central point of reference for providers to help with routine service inquiry, including verifying eligibility and explaining benefits, claims, and appeal procedures
- Maintained compliance with HIPAA and state requirements / regulations within both existing and future lines of business while adhering to departmental policies
- Enhanced employees’ productivity by mentoring team members and promoting a culture of shared knowledge and insights
- Ensured running of operations at optimal level by handling administrative tasks, such as processing claims and incoming faxes or web inquires
- Strengthened provider relationships for seamless delivery of all related services to clients while routing calls to support pharmacy and triage departments for prompt resolution
- Increased client satisfaction through high quality service delivery by timely responding to requests or complaints and escalating matters to relevant department.
Bluestream Professional Services
PROJECT COORDINATOR: TCAP REPORTING / CREW ADMINISTRATOR
01.2014 - 01.2015
Job overview
- Generated 18% YoY increase in recovering claim awards by demonstrating exceptional work ethic and dedicated commitment towards first-class service delivery
- Managed crew development and allocation to regions nationwide, including scheduling crews of civil engineers and addressing exceptions for cellular technology tower builds and maintenance assignments
- Kept stakeholders informed for critical decision making by efficiently compiling and presenting all internal and external metric reconciliation reports to management
- Upheld 100% accuracy, timeliness, and confidentiality for uploading entry into client project management software
- Collaborated with project managers and site acquisition specialists for resolving data discrepancies while supporting back office requests, i.e
- Invoicing, change orders, crane, and SLAF purchase orders
- Initiated real-time operational planning by managing updated professional services and customers’ systems regarding crew tracking reports based on dates forecasted for workload requests
- Improved service delivery and individual member capacity through execution of performance audits.
Hire Dynamics
HEALTH INFORMATION SCHEDULER: ACCOUNTS PAYABLE RESEARCHER
01.2014
Job overview
- Worked closely with officials of health care provider offices, clinics, hospitals, other clinical facilities requesting specific medical records for risk adjustment reviews
- Involved in following up on delinquent requests by submitting faxes for USPS or FEDEX labels, expediting the charts retrieval
- Ensured continuous professional development by completing required training, testing, and quality assessments for HIPAA policies
- Provided support in processing a high-volume invoice inquires for health plans patient chart copy costs
- Produced an integral part in coordinating PIA (Payment Integrity Audits) to ensure correct billing to CMS and HEDIS (Healthcare Effectiveness Data and Information Set) requests
- Accomplished information accuracy by researching data and documenting Odis operating system for paid and received invoices and submitting for payment processing.
LiveOps
INDEPENDENT CONTRACTOR: SALES SERVICE / ORDER ENTRY REPRESENTATIVE
01.2012 - 01.2014
Job overview
- Accelerated company’s revenue stream through inbound phone calling to sell food packages, programs, and nutritional products for a variety of infomercials, catalogs, and Fortune 500 companies
- Accelerated client experience by professionally interacting with diverse customers on a regular basis; utilizing exceptional communication and customer service skills within a virtual call center environment.
Education
Bradley Bourbonnais Community HighBradley, IL
High School Diploma
05.2001
University Overview
Skills
Conflict Resolutionundefined
Availability
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Quote
Start where you are, use what you have, do what you can.
Timeline
TEMPORARY HEALTH PROGRAM REPRESENTATIVE
BCforward/Anthem
01.2023 - 08.2023
CUSTOMER SERVICE & COLLECTIONS REPRESENTATIVE
Wellstar Health Systems
01.2020 - 01.2022
CUSTOMER ADVOCATE: PROVIDER SERVICE REPRESENTATIVE II
Caresource
01.2017 - 01.2021
PROJECT COORDINATOR: TCAP REPORTING / CREW ADMINISTRATOR
Bluestream Professional Services
01.2014 - 01.2015
HEALTH INFORMATION SCHEDULER: ACCOUNTS PAYABLE RESEARCHER
Hire Dynamics
01.2014
ADMINISTRATIVE MANAGER
Clearechoice Solutions
05.2012 - Current
INDEPENDENT CONTRACTOR: SALES SERVICE / ORDER ENTRY REPRESENTATIVE
LiveOps
01.2012 - 01.2014
Bradley Bourbonnais Community High
High School Diploma
05.2001