Leah Roy
Harrison,MI
Summary
Diligent and experienced Medicare Customer Service Representative with solid background in handling customer interactions. Proven track record of efficiently resolving customer inquiries and maintaining high satisfaction rates. Demonstrated ability to leverage communication and problem-solving skills to enhance customer experience.
Overview
20
20
years of professional experience
Work History
Medicare Customer Service Representative
Corewell Health/Priority Health
Grand Rapids, MI/REMOTE
04.2025 - Current
- Resolved customer inquiries regarding Medicare benefits and coverage options.
- Educated members on claims processes and provided detailed explanations of policy terms.
- Collaborated with healthcare providers to ensure accurate billing and service delivery.
- Reviewed authorization systems and appeals for status updates to member's and effectively explain approvals and denials for services.
- Utilized company systems to track interactions and maintain comprehensive member records.
- Communicated with D-SNP and HIDE-SNP member Care Management team about member's benefits and authorizations.
- Additional training on Priority Health HIDE-SNP plan, D-SNP plan, Employer Group plans, and Sales Agent calls.
- Accepted as an iThink committee member to help improve Customer Service materials and knowledge articles.
Office Manager / Physical Therapy Technician
Evergreen Physical Therapy
Harrison, MI
02.2014 - 03.2025
- Checked patient insurance, demographic, and health history to keep information current for approximately 30 patients per day in office.
- Scheduled patients, verify medical insurance, collect over-the-counter payments, post mail and OTC payments.
- Coordinated medical records for insurance authorization appeals and scheduled peer-to-peer reviews.
- Utilize electronic medical records system.
- Helped patients complete necessary medical forms and documentation.
- Ensured HIPAA compliance by maintaining strict confidentiality with all patient records and information.
- Make preparations for yearly internal audit by reviewing charts, reports, making sure MSDS binder is up-to-date.
- Keep "Emergency Preparedness Binder" current and items within office to aid with policies within binder.
- Coordinated several company wide events including organizing catering, venue, and invitations to events for 5 Physical Therapy clinics.
- Technician work includes performing ultrasound treatments and utilizing vasopneumatic device.
- Other duties included keeping office organized, laundering used linens, and assisting other clinical staff.
Cashier, Inventory Stock & Care, Customer Service
Hall's Greenhouse
Swartz Creek, MI
03.2011 - 08.2013
- Greeted approximately 80 customers per day entering store and responded promptly to customer needs.
- Welcomed customers and helped determine their needs.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Restock inventory and water and prune plants.
Photography Intern
The Special Olympics of Michigan
Mount Pleasant, MI
09.2012 - 05.2013
- Edited, toned, captioned, and uploaded photographs for publication.
- Attend Special Olympic events to shoot photos, edit photos for use on social media, then upload photos to server for general use.
- Put together shot list for events and assisted other interns with photography.
- Help prepare and organize for events with marketing team.
- Involved use of InDesign software and Photoshop CS6.
Team Leader, Cashier
Central Michigan University Campus Dining
Mount Pleasant, MI
09.2011 - 05.2013
- Maintained an inclusive and diverse team culture for 8 employees, promoting respect and understanding among all members.
- In charge of counting cash drawers, keeping track of inventory and checking employee deposits.
- Stocked shelves, check out customers, and made custom drink products for customers.
Cashier, Hostess
Bob Evans Restaurant
Fenton, MI
05.2006 - 09.2011
- Greeted customers and seated them within restaurant.
- Cash out customers, assist with Carry-Out orders, restock waiting room inventory.
- Assist with waitress and bussing needs as necessary.
Education
Some College (No Degree) - Undergraduate Studies
Western Michigan University
Kalamazoo, MIBachelor of Science - Photojournalism
Central Michigan University
Mount Pleasant, MI05-2013
High School Diploma -
Linden High School
Linden, MI05-2009
Skills
- Service Excellence
- Office Coordination
- Effective Organization
- Office Management
- Experienced with LENS LEX Production
- Expertise in Raintree 94 & 102
- Medical Insurance Verification and Authorization Websites
- Professional Photography
- Proficient in Microsoft Office
- Final Cut Pro Proficiency
- Experienced with Adobe Photoshop CS6
- Experienced in Adobe InDesign
- Customer service
Timeline
Medicare Customer Service Representative
Corewell Health/Priority Health
04.2025 - Current
Office Manager / Physical Therapy Technician
Evergreen Physical Therapy
02.2014 - 03.2025
Photography Intern
The Special Olympics of Michigan
09.2012 - 05.2013
Team Leader, Cashier
Central Michigan University Campus Dining
09.2011 - 05.2013
Cashier, Inventory Stock & Care, Customer Service
Hall's Greenhouse
03.2011 - 08.2013
Cashier, Hostess
Bob Evans Restaurant
05.2006 - 09.2011
Some College (No Degree) - Undergraduate Studies
Western Michigan University
Bachelor of Science - Photojournalism
Central Michigan University
High School Diploma -
Linden High School