LaQuawn Jones
Summary
Motivated and resourceful professional with a reputation for quality, proficiency, and reliability in service-oriented positions seeking to use medical education and practical experience to healthcare industry. Seeking to combine skills and dynamic medical education into opportunities to enter the healthcare field with an innovative organization. Productive call center representative with several years of experience building rapport with clients and providing quality support. Gifted in answering large volume of customer calls and resolving customer complaints. Recognized for consistently earning top customer satisfaction ratings. Accommodating Customer Support Specialist with documented history of exceeding customer and patron expectations. Calm and composed in stressful situations with successful record of reducing customer dissatisfaction through acknowledgment, decisive communication and focused solutions. Expert at finding win-win solutions. Detailed Client Service Associate known for having great organizational skills. Gifted at working with all types of customers. Looking for a new role where hard work and dedication will be highly valued.
Overview
13
13
years of professional experience
Work History
Inbound Contact Representative Go365
Humana
06.2023 - Current
- Investigated and resolved customer inquiries and complaints quickly.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Cross-trained and provided backup support for organizational leadership.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
- Met customer call guidelines for service levels, handle time and productivity.
- Resolved associate, tool and service delivery issues revealed by statistical reports.
Benefits and Claims Rep/Medical Claims Processor
Humana- Remote
06.2022 - 06.2023
- First point of contact for members and providers
- Assist with claims questions/concerns
- Assist with benefits questions/concerns
- Meet monthly goals.
- Responded to correspondence from insurance companies.
- Utilized various software programs such as CRMs and ticketing systems to provide support.
- Assessed customer complaints to determine eligibility for appeal or grievance filing.
- Educated customers about billing, payment processing and support policies and procedures.
- Cross-trained and backed up other customer service managers.
- Paid or denied medical claims based upon established claims processing criteria.
Remote ROI Specialist
Ciox Health/Mayo Clinic-Remote
03.2020 - 06.2022
- Process Request for medical records
- QA records for any discrepancies
- Meet Daily Goals.
ROI Specialist
Ciox Health/ Navicent Health- Macon, Ga
06.2019 - 03.2020
- Answer Phones
- Receive Request for Medical records that are hipaa compliant
- QA and ensure that the records are correct
- Fax records to the respective requestors
- Complete Zoll Request.
Medical Receptionist/Medical Billing & Coding
Dr. Kavuri MD Pediatrics- Dublin, Ga.
10.2018 - 06.2019
- Greet Patients, answer phone calls, schedule appointments, check eligibility and update GRITS with recent immunizations
- Bill Medicaid, Wellcare, Peachstate, Caresource and all private insurance for the office
- Take patients to the back, take notes on any illnesses that the patients have going on, prepare for any immunizations they will be receiving, give handouts on the shots that they will be receiving.
Payment Recovery Unit Technician
Geico - Macon, GA
05.2014 - 10.2018
- Receives payment recovery referrals from claims associates
- Analyzes, pursues and recovers monies, to include physical damage and rental coverage's
- Maintains communication with providers and policyholders throughout the subrogation process.
Certified Nursing Assistant
Oaks Nursing Home - Marshallville, GA
03.2014 - 05.2014
- Attended to the individual needs of patients including assistance with grooming, bathing, oral hygiene, feeding, incontinent care, toileting, colostomy care, prosthetic appliances, transferring, ambulation, range of motion or other needs in keeping with the individuals' care requirements
- Communicated and interacted effectively and tactfully with patients, visitors, families, peers and supervisory staff
- Completed various tasks assigned by supervisory staff, including checking vital signs, weighing residents, applying creams/ointments and collecting specimens.
Corrections Officer
Dooly State Prison - Unadilla, GA
07.2011 - 02.2014
- Supervised inmates in housing units and those segregated for administrative or punitive measures
- Checked inmate mail for possible contraband; maintained a periodic patrol either inside or outside the institution to ensure the security and integrity of the institution
- Instructed inmates and maintain control in areas such as the inmate food service area, auditorium, etc
- Maintained a record of equipment, supplies and other items
- Maintained master inmate location counts; setup and received inmate counts and remained familiar with the entire operation of the Control Room
- Maintained proper security of inmates being transported.
Education
Associates of Science Degree - Pre Nursing -
Georgia Military College
01.2023
Associate of Science Degree - Healthcare Management -
Ultimate Medical Academy
01.2018
Skills
- Written and verbal communication
- Proofreading and editing
- Decision-making skills
- Problem solving skills
- Critical thinking skills
- Social Perceptiveness
- Empathy and patience
- Goal-Oriented
- Cross-cultural sensitivity
- Payment Processing
- Assertiveness
- Technical Support
- [Software] CRM system expert
- Call Center Customer Service
- Customer communications
- Quick Typing
- CRM Software
- Order Processing
- Online Etiquette
- User Support
- Data entry proficiency
- Complaint resolution
- Customer Relationship Management
- Call Control
- Data Entry
- Quality Assurance
- Customer Service
- Verbal and written communication
- Technical Troubleshooting
- Call Center Operations
Timeline
Inbound Contact Representative Go365
Humana
06.2023 - Current
Benefits and Claims Rep/Medical Claims Processor
Humana- Remote
06.2022 - 06.2023
Remote ROI Specialist
Ciox Health/Mayo Clinic-Remote
03.2020 - 06.2022
ROI Specialist
Ciox Health/ Navicent Health- Macon, Ga
06.2019 - 03.2020
Medical Receptionist/Medical Billing & Coding
Dr. Kavuri MD Pediatrics- Dublin, Ga.
10.2018 - 06.2019
Payment Recovery Unit Technician
Geico - Macon, GA
05.2014 - 10.2018
Certified Nursing Assistant
Oaks Nursing Home - Marshallville, GA
03.2014 - 05.2014
Corrections Officer
Dooly State Prison - Unadilla, GA
07.2011 - 02.2014
Associates of Science Degree - Pre Nursing -
Georgia Military College
Associate of Science Degree - Healthcare Management -
Ultimate Medical Academy
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