Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

LaQuita Curlin

Houston,TX

Summary

Dynamic professional with a solid track record at KelseyCare Advantage, specializing in healthcare and multichannel communication. Demonstrated excellence in managing member correspondence and effectively tracking complaints, leading to a notable improvement in customer support. Proficient in membership renewals, showcasing strong problem-solving skills and a dedication to delivering exceptional service.

Overview

11
11
years of professional experience

Work History

Member Service Representative

KelseyCare Advantage
Pearland, TX
08.2022 - Current
  • Researched complex issues related to accounts or services provided by the organization.
  • Handled customer complaints in an efficient and courteous manner.
  • Provided support to members regarding accounts processing new plans, and resolving issues.
  • Greeted customers in a friendly and professional manner.
  • Responded promptly to emails from members and management seeking assistance.
  • Adhered to all applicable policies, procedures, regulations, and laws.
  • Verified identity information on new accounts using established procedures.
  • Answered incoming calls regarding membership benefits and services.
  • Engaged in conversation with customers to understand needs, resolve issues and answer questions.

Patient Financial Representative

Houston Behavioral Healthcare Hospital
05.2021 - 08.2022
  • Verified insurance benefits and registered patients
  • Knowledge of Behavioral Health carve out insurance
  • Authorization Verification for patient's treatments
  • Conduct follow-up calls or meetings with custodians of records
  • Follow-up with each patient on their Out of Pocket collections
  • Fully document all transaction requests into the system
  • Ensured all collection activities are in compliance with State and Federal collection laws
  • Conducted detailed discussion with patients, obtains information and completes required tasks to determine patient's eligibility for Medicaid and other federal, state, and local government or private sources as appropriate
  • Performed yearly billing audits

Legal Tech

Confidential Communications International, LTD
09.2018 - 05.2019
  • Collect records of inbound and outbound calls.
  • Conduct follow-up calls or meetings with custodians of records.
  • Prepare emails and faxes for clients.
  • Prepared reports summarizing patient information as requested by physicians or other healthcare providers.
  • Conducted periodic audits of physical documentation versus electronic health records.
  • Provided training to staff members on proper documentation techniques for medical records.

Customer Service Agent

Academy Sports & Outdoors
10.2015 - 02.2017
  • Answered incoming calls promptly and professionally within company standards.
  • Tracked orders from placement to delivery using internal systems.
  • Assisted customers with inquiries regarding products and services through phone, email, and chat.
  • Resolved customer complaints quickly and efficiently.
  • Provided technical support over the phone when needed.
  • Delivered fast, friendly, and knowledgeable service for routine questions and service complaints.

CM2000 Time Coordinator Supervisor

Emmanuel Health Homecare
Houston, Texas
03.2015 - 09.2015
  • Input the time in and out for all providers.
  • Input 2067 and Plan of Care Changes.
  • Managed daily operations related to employee scheduling such as approving time off requests or assigning shift swaps.
  • Resolved inquiries regarding schedule changes, or the availability of services and products.
  • Maintained up-to-date records of staff availability, absences, holidays, and vacations.
  • Managed weekly payroll duties and submitted data to payroll contractor.
  • Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.

Customer Service Agent

Amerigroup
Houston, Texas
12.2013 - 03.2015
  • Ensured compliance with state regulations related to utilization management activities.
  • Maintained accurate records on all prior authorizations requested, received, and denied.
  • Provided timely feedback to physicians regarding authorization status.
  • Researched medical policies to ensure appropriate coverage of services.
  • Assessed insurance benefits and determined eligibility criteria.
  • Analyzed claims data from multiple sources to identify areas of potential cost savings.
  • Educated customers about the prior authorization process including applicable deadlines.
  • Reviewed prior authorization requests for completeness and accuracy.

Education

High School -

Eisenhower High School
Houston, TX
05.2000

Skills

  • Membership renewals
  • Member correspondence
  • Tracking complaints
  • Healthcare
  • Customer support
  • Multichannel communication

References

Upon Request

Timeline

Member Service Representative

KelseyCare Advantage
08.2022 - Current

Patient Financial Representative

Houston Behavioral Healthcare Hospital
05.2021 - 08.2022

Legal Tech

Confidential Communications International, LTD
09.2018 - 05.2019

Customer Service Agent

Academy Sports & Outdoors
10.2015 - 02.2017

CM2000 Time Coordinator Supervisor

Emmanuel Health Homecare
03.2015 - 09.2015

Customer Service Agent

Amerigroup
12.2013 - 03.2015

High School -

Eisenhower High School

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LaQuita Curlin