LE'KEEYA FONTENOT
Customer Service
Antioch,California
Summary
Detail-oriented and customer-focused professional seeking a challenging position as a Teleservice Representative. Dedicated to providing exceptional customer service and support over the phone, ensuring prompt resolution of inquiries, accurate appointment scheduling, and efficient handling of member information.
Overview
20
20
years of professional experience
Work History
Customer Service Concierge Support
Blue Shield of California
04.2023 - 10.2023
- Provide deductible and max out of pocket information.
- Assist members on when and how to appeal a coverage decision.
- Accurately collect and record member information, including demographic details.
- Managed incoming calls regarding member eligibility, benefits, provider information, and monthly premium billing.
- Assisted members in locating in-network providers and pharmacies within their area, ensuring access to necessary healthcare services.
- Coordinated membership changes, including updates to members primary care physicians, ensuring accuracy and timely processing.
- Assisted members by providing clear explanations of insurance benefits, coverage limitations, and out-of-pocket costs to enhance their understanding of financial responsibilities.
- Documented interactions and maintained detailed records to ensure compliance with company policies and procedures.
- Directed incoming calls to appropriate internal personnel and departments, effectively routing inquiries to the best-qualified team for resolution.
- Streamlined communication processes to enhance operational efficiency and improve response times for member inquiries ensuring accuracy and timely processing.
- Maintained strict confidentiality while handling sensitive patient information, adhering to HIPAA guidelines and company policies.
- Investigated and resolved members inquiries and complaints quickly.
- Managed a high volume of incoming calls, prioritizing urgent requests and maintaining professional communication at all times.
- Provided empathetic support to members dealing with difficult health situations, offering resources when appropriate to help ease their concerns.
Fact Finding Agent-Employer Protest
Employment Development Department
11.2021 - 03.2023
- Analyzing claim information to identify discrepancies or missing information'
- Assessing the information against requirements based on UI code, policies, and procedures.
- Determine claimant eligibility for UI benefits in accordance with the laws and policies.
- Collaborated with employers to verify job details, income, and reasons for claimant separation, ensuring accurate assessment of UI eligibility.
- Maintained meticulous documentation of all gathered facts and evidence to support UI eligibility determinations, ensuring a 98% accuracy rate in claim processing.
- Analyzed and compared employer and claimant statements to identify potential discrepancies or conflicts in 100+ UI claims per week.
- Identifying possible false statements and fraudulent claims and reporting to the Investigation Division.
- Conducted in-depth research and analysis to determine claimant eligibility for UI benefits in accordance with state laws, policies, and procedures.
- Resolving all eligibility issues surrounding claimant's unemployed status, determining claimant's eligibility for benefits, and informing claimant and employer of decision; Notating all actions taken on a claim clearly and thoroughly.
- Processed and mailed out unemployment determination letters to claimants and employers, communicating the eligibility decisions in a clear and timely manner.
- Documented all actions taken on each claim, including the information gathered, analysis performed, and final determination, to maintain a comprehensive record.
- Contributed to the department's overall success in providing timely and accurate UI benefits to eligible claimants by consistently adhering to established policies and procedures.
- Accurately updated member demographic information, including contact details, employment status, and other relevant data, in the department's internal database and case management system.
- Reviewed appeal requests from denied claimants, making determinations based on legal guidelines and individual case factors.
- Collaborated with other departments to develop streamlined processes for sharing information related to unemployment claims.
- Expedited claim approvals by effectively prioritizing workload and managing deadlines.
- Demonstrated strong investigative and problem-solving skills to resolve complex UI cases.
Patient Enrollment Specialist/Medical Billing
Alere Home Monitoring
09.2016 - 08.2019
- Received and responded to high volumes of inbound phone calls from patients reporting their International Normalized Ratio (INR) test results.
- Accurately document patient INR values.
- Provide clear and concise communication to ensure patients understand their INR values and any necessary next steps.
- Collaborate with healthcare providers to escalate critical or abnormal INR results.
- Assisting patients with ordering INR meter and testing supplies.
- Enroll patients in the INR (International Normalized Ratio) self-testing program.
- Educate patients on the proper use of INR self-testing devices and provide training as needed.
- Submit patient claims electronically to insurance providers, ensuring accurate documentation and timely reimbursement.
- Accurately collect and record member demographic details, including contact information, insurance coverage, and specific instructions from healthcare providers.
- Maintain detailed member records in the electronic database, ensuring data accuracy and integrity.
- Accurately collect and review patient insurance information, including coverage details, copayments, deductibles, and coinsurance.
- Utilize online portals and phone-based systems to verify patient eligibility and benefits in a timely manner.
- Maintain detailed records of eligibility and benefits verification in the electronic medical record system.
- Prepare and submit medical claims to insurance companies electronically using established protocols and procedures.
- Maintained strict confidentiality of patient information in compliance with HIPAA regulations.
- Processed calls from hearing-impaired members using appropriate communication methods, such as: Utilizing live-transcribe devices like teletypewriters (TTY) to enable text-based communication.
- Works collaboratively with other departments.
- Enhanced customer satisfaction with personalized enrollment assistance.
- Enhanced team productivity through effective time management and prioritization techniques during peak enrollment periods.
- Enhanced customer service by promptly addressing inquiries and resolving issues in a timely manner.
Quality Assurance Specialist/CSR
Callsocket
09.2015 - 07.2016
- Use call recording software to capture and review agent calls on a regular basis.
- Document feedback and coaching provided to agents based on call evaluations.
- Utilize call recording software to capture agent-customer interactions.
- Collaborated with call center teams to conduct regular calibration sessions to ensure consistent evaluation of agent call quality.
- Actively contributed to discussions and reached consensus on standardized scoring criteria and call assessment procedures.
- Provided regular, constructive feedback to call center agents on their performance and customer interactions.
- Collaborated with agents to identify areas for improvement and develop personalized action plans to enhance their skills.
- Regularly met with team leads and managers to discuss agent performance trends and recommend targeted coaching strategies.
- Demonstrated strong interpersonal and communication abilities to deliver feedback in a manner that was well-received and motivated agents to grow professionally.
- Sales agents followed training scripts and customers were satisfied with agent performance
- Utilized active listening techniques, empathy, and conflict resolution strategies to de-escalate tense interactions and find mutually agreeable solutions.
- Demonstrated exceptional call handling skills in a fast-paced, high-volume contact center environment.
- Quickly assessed the purpose of each customer's call and followed established protocols to address their needs efficiently.
- Proactively reached out to sales leads and prospective customers to provide personalized assistance with the application process.
- Guided individuals step-by-step through the completion and submission of online applications, ensuring all required information was accurately provided.
- Scheduled follow-up consultations with qualified leads to further discuss their needs and match them with the appropriate products or services.
- Demonstrated a thorough understanding and consistent adherence to all relevant departmental standards, policies, and procedures.
- Meticulously documented and updated customer demographic information, including contact details, account history, and any relevant notes or special instructions.
Customer Service Representative
Apple One
06.2015 - 08.2015
- Ensured the timely review and processing of all incoming messages to provide prompt responses and resolutions to employees with their Paid Sick Leave.
- Responded to management inquiries for Sick Leave balances for benefited and non-benefited employees.
- Instructed management on proper Paid Sick Leave coding in time system.
- Monitored the time system data to identify any discrepancies or inconsistencies in the way paid sick leave was being recorded, and worked with managers to address any issues.
- Participated in California Paid Sick Leave webinars.
- Prepared binders for the Paid Sick Leave Ordinance support team.
- Prepared 400 folders to meet presenters needs for Saturday Retirement Workshops within a one day turn around.
- Performs other duties as required.
- Maintained 2015 retirement workshops spreadsheets.
Education
GED -
Mt. Diablo
Concord, CA06.2002
NHA Certified Medical Administrative Assistant -
Contra Costa Medical Career College, Inc.
Antioch, CA 05.2001 -
Skills
Ability to Work in a Team
Computer Skills
Fast Learner
Microsoft Office Word
Ability to Work Under Pressure
Ability to Multitask
Microsoft Excel
Microsoft Office
Resolving Customer Problems
10 years in Customer Service
15 years Inbound Call Center Environment
Ability to Work Under Pressure
Resolving Customer Issues
Policy and Procedure Adherence
Inbound Phone Call Management
High Volume Calls
References
References available upon request
Timeline
Customer Service Concierge Support
Blue Shield of California
04.2023 - 10.2023
Fact Finding Agent-Employer Protest
Employment Development Department
11.2021 - 03.2023
Patient Enrollment Specialist/Medical Billing
Alere Home Monitoring
09.2016 - 08.2019
Quality Assurance Specialist/CSR
Callsocket
09.2015 - 07.2016
Customer Service Representative
Apple One
06.2015 - 08.2015
NHA Certified Medical Administrative Assistant -
Contra Costa Medical Career College, Inc.
05.2001 -
GED -
Mt. Diablo