Ms Word, Excel, Cosmos, Facets, Outlook, Teams,
Leslie Jackson
Las Vegas,NV
Summary
Gifted customer service team member focused on handling customer issues and escalated requests with fast and knowledgeable support. Well-versed in Medical Terminology Billing, and coding procedures and skilled at assessing trends to devise creative system-wide solutions. Excellent relationship-building, communication and conflict mediation skills.
Overview
19
19
years of professional experience
Work History
Customer Service Care Coordinator
United Healthcare
09.2021 - 04.2024
- Strategically answer inbound calls from members, auth reps, agents, and other third parties in reference to plan navigation for government and community and state programs. Daily activities included but were not limited to claims status, billing inquires, eligibility authorization status, pre/post services, grievances and appeals, coverage determinations, rx overrides, rx rejections, website navigation to name a few.
- Also responsible for providing concierge and white-glove level service, removing burdens and providing end-to-end resolution for customers.
Serve as a single point of contact for the customer and form a strong relationship to support them
Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience.
Respond to and own consumer inquiries and issues
Conduct proactive research on assigned member accounts to identify service issues.
Identify Gaps in processes and work closely with other departments for process improvement.
Provide Education and status on previously submitted pre-authorizations or pre-determination requests
Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance.
Provider Services Representative
Cigna
09.2018 - 09.2020
- Professionally answer inbound calls from, providers, regarding benefits and eligibility
Claims status, on Medicare Supplement/Medicare Advantage plans, life policies and health policies
Reprocessing of claims, policy changes, website navigation, and retirement Appeals and Grievances prior authorizations, credentialing, provider enrollment, provider data management and contracting issues.
Member Services Rep
Hcs Healthcare Scouts
02.2018 - 05.2018
- Effectively answered inbound calls on Pharmacy help desk from members and providers related to benefits, and eligibility, eligibility, claims status, refills, prior authorizations for medications. Relative to state medicaid programs and other pbm, pdp plans. Also assisted with drug recalls, drug interactions, assisted with setting up peer to peer along with assisting local retail pharmacies on processing prescriptions through thoroughly to ensure payment.
Member Service Representative
US Tech Solutions Inc
07.2016 - 02.2017
- Professionally answered inbound calls from members, providers, brokers and beneficiaries, funeral homes, regarding life policies, and Medicare Supplement plans
- Assisted with claims status, benefits and Eligibility, prior authorizations, and coordination of benefits
- Assisted brokers and agents with rejected applications and final expense on life policies.
Hedis Project Assistant
Robert Half / Office Team United Health Care
01.2016 - 05.2016
- Answered inbound calls on provider hotline regarding the Hedis Project for Par and non Par providers for United Health Care
- Provided general administrative and clerical duties in collection of medical records from hospitals and labs, and doctors offices from our vendors Altegra, Healthport, and Chartpro
- Opened sorted and distributed incoming mail, performed data entry and scanned all documents for hard copy filing system.
Member Service Representative
Prime Therapeutics LLC
10.2011 - 02.2012
- Answered inbound calls from members and providers related to blue plans pharmacy benefits
- Processed mail order payments, drug interactions, drug recalls, prior authorizations, and pharmacy claims
- Also assisted local retail pharmacy with processing of prescriptions as well.
Customer Service Representative III
Beechstreet A Viant Network/Multiplan
09.2008 - 09.2009
- Received inbound calls from providers regarding claim status, claims reprocessing, claim payments within the ppo network.
- Other duties were fee schedules, contracting issues, fee negotiations, provider enrollment, and credentialing providers
- Additionally loading provider data , appeals, 2nd level appeals.
Provider Service Representative
United HealthCare Services Inc
09.2005 - 02.2008
- Primary responsibilities were taking inbound calls from providers relative to network issues, contracting issues, fee schedules, provider enrollment, and provider data management
- Other duties were processing 2nd level appeals, for Commercial and Medicare plans.
Education
Certification - Medical Billing/Coding
American Career College
Los Angeles, CAHigh School Diploma -
Dominguez High School
Compton, CA06.1988
Skills
- Compliance Champion
- Team Coaching
- Interdepartmental Collaboration
- Staff Support
- Calm and Professional Under Pressure
- Motivational Leadership
Software
Timeline
Customer Service Care Coordinator
United Healthcare
09.2021 - 04.2024
Provider Services Representative
Cigna
09.2018 - 09.2020
Member Services Rep
Hcs Healthcare Scouts
02.2018 - 05.2018
Member Service Representative
US Tech Solutions Inc
07.2016 - 02.2017
Hedis Project Assistant
Robert Half / Office Team United Health Care
01.2016 - 05.2016
Member Service Representative
Prime Therapeutics LLC
10.2011 - 02.2012
Customer Service Representative III
Beechstreet A Viant Network/Multiplan
09.2008 - 09.2009
Provider Service Representative
United HealthCare Services Inc
09.2005 - 02.2008
Certification - Medical Billing/Coding
American Career College
High School Diploma -
Dominguez High School
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