Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Leslie Tynes

Norfolk,VA

Summary

Experienced Customer Service Specialist with over 5 years in the insurance sector, specializing in handling escalated issues and ensuring compliance with industry standards. Adept at multi-tasking and maintaining professionalism in high-pressure situations, with a proven track record of enhancing customer satisfaction and loyalty.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Customer Service Representative I

Anthem
Norfolk, VA
12.2021 - Current
  • Handled insurance claims, including pharmacy and medical authorizations, ensuring compliance with legal and company standards.
  • Investigated denials from payers for lack of medical necessity or level of care issues.
  • Communicated with patients with compassion while keeping medical information private.
  • Liaised between patients, healthcare providers, and insurance companies to clarify coverage and authorize services.

Remote Customer Specialist I

Apex Systems
Virginia Beach, VA
05.2021 - 10.2021
  • Answered incoming customer inquiries via phone, email and live chat.
  • Followed communication procedures, guidelines and policies.
  • Developed strong relationships with customers to ensure satisfaction and loyalty.
  • Identified potential issues that may negatively affect customer satisfaction and took corrective action to resolve them in a timely manner.
  • Demonstrated excellent communication skills when interacting with customers both verbally and in writing.
  • Managed multiple tasks simultaneously while providing prompt service to customers.

Remote Insurance Agent

Spectraforce Staffing
Raleigh, NC
09.2020 - 02.2021
  • Ensured compliance with applicable laws, regulations, and company policies while selling insurance products.
  • Advised customers on the best ways to minimize risks associated with their assets.
  • Maintained accurate records of all insurance transactions using computer software systems.
  • Educated customers on the importance of maintaining adequate insurance coverage.
  • Processed payments received from clients promptly according to established procedures.
  • Explained complex technical terms related to insurance plans in simple language for easy understanding.

Insurance Agent

Sutherland Global
Chesapeake, VA
09.2015 - 02.2020
  • Managed high-volume inbound and outbound calls to address customer inquiries and claims.
  • Ensured compliance with company guidelines and regulatory standards when dealing with customers' accounts or policies.
  • Facilitated payment processing for premium payments and renewals.
  • Advised customers on available coverage options that best fit their individual needs.
  • Greeted customers and provided prompt, courteous service.
  • Provided quotes on various types of insurance policies.
  • Researched relevant policy information to answer customer questions.
  • Answered insurance-related questions and discussed product offerings with prospective customers to meet unique needs.

Utilization Management Representative

Aerotek Staffing Staffing
Virginia Beach, VA
02.2015 - 09.2015
  • Evaluated the need for additional information from providers or members to support a request for service authorization.
  • Analyzed medical records to assess the level of care, utilization trends, and resource utilization.
  • Ensured that all authorizations are documented accurately in the patient's medical record.
  • Liaised between patients, healthcare providers, and insurance companies to clarify coverage and authorize services.
  • Performed pre-certification, concurrent, and retrospective reviews of inpatient and outpatient services.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.

Education

High School Diploma -

Booker T Washington High School
Norfolk, VA
06-2004

Associate of Applied Science - Information Technology

Tidewater Community College
Norfolk, VA

Skills

  • Complaint resolution
  • Call Management
  • Data Entry
  • Multi-Task Management
  • Problem-solving abilities
  • Adaptive team player
  • Microsoft Office Suite
  • Critical Thinking
  • Conflict Resolution
  • Medical terminology knowledge
  • Analytical and Research Skills
  • ICD 10 codes
  • Insurance Practices
  • Active Listening

Certification

  • Active Public Trust Clearance

Timeline

Customer Service Representative I

Anthem
12.2021 - Current

Remote Customer Specialist I

Apex Systems
05.2021 - 10.2021

Remote Insurance Agent

Spectraforce Staffing
09.2020 - 02.2021

Insurance Agent

Sutherland Global
09.2015 - 02.2020

Utilization Management Representative

Aerotek Staffing Staffing
02.2015 - 09.2015

High School Diploma -

Booker T Washington High School

Associate of Applied Science - Information Technology

Tidewater Community College

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Leslie Tynes