Liza Wilson
Jefferson City,MO
Summary
Dedicated customer service professional with expertise in empathy, problem solving, and HIPAA compliance. Proven track record in first call resolution and accurate documentation, consistently enhancing customer satisfaction and operational efficiency.
Overview
27
27
years of professional experience
Work History
Member Services Team Member
Intelogix LLC
Park City, UT
04.2026 - Current
- Provided account information for Entergy customers
- Update demographics
- Assisted with billing and payment arrangements
- Issued work orders for start, stop and move services
- Issued reports on outages and emergencies.
- Heavy phone contact
- Documented all interactions with Entergy customers
- Provided community services program information
- Delivered exceptional customer support by resolving inquiries and issues efficiently.
- Assisted in onboarding new members, enhancing their understanding of services offered.
- Maintained accurate member records using CRM software, ensuring data integrity.
- Collaborated with cross-functional teams to streamline processes and improve service delivery.
Medicaid Member Service Rep
Results Customer Solutions
Fort Lauderdale, FL
10.2024 - 05.2025
- Handled 100+ inbound Medicaid member calls daily in a fast-paced contact center environment, supporting high-volume service demands.
- Provided clear, member-friendly explanations of Medicaid eligibility, benefits, coverage, and account updates using layman’s terms to improve understanding and engagement.
- Performed HIPAA-compliant identity verification prior to releasing protected health information, ensuring privacy and regulatory compliance.
- Resolved routine Medicaid inquiries on first call, escalating complex or claims-related issues to appropriate internal departments as needed.
- Assisted members with billing concerns and incorrect balance billing, coordinating with claims teams to ensure adherence to Medicaid guidelines.
- Delivered support to 500+ Medicaid members monthly, maintaining a 95% customer satisfaction rate.
- Educated members on available benefits and programs, contributing to increased utilization and informed decision-making.
- Documented all member interactions accurately in CRM systems for quality assurance, performance tracking, and audit readiness.
- Conducted follow-up outreach to confirm resolution and ensure members received appropriate care and services.
Business-to-Business Customer Service Rep.
Wayfair LLC
Boston, MA
08.2023 - 04.2024
- Supported business clients with post-order inquiries via phone, email, and chat in a high-volume service environment.
- Resolved issues related to order tracking, shipping delays, returns, replacements, and refunds through effective problem-solving.
- Provided accurate product information and account support to ensure smooth order fulfillment.
- Applied strong empathy and communication skills to guide customers through complex post-order concerns.
- Documented interactions and resolutions in internal systems to maintain service quality and client satisfaction.
- Resolved customer inquiries, ensuring timely and accurate responses to enhance satisfaction.
- Managed order issues, coordinating with logistics to streamline delivery processes.
- Trained new representatives on customer service protocols and systems.
- Analyzed customer feedback to identify trends and implement service improvements.
Customer Service Representative – Mental Health
Carelon Behavioral Health
Clayton, MO
06.2023 - 08.2023
- Assisted members and providers with behavioral health benefit inquiries, ensuring accurate information and appropriate resource guidance
- Maintained strict HIPAA compliance and confidentiality standards when handling sensitive mental health information
- Demonstrated strong empathy, active listening, and de-escalation skills while supporting members experiencing emotional distress or complex care needs
- Directed members to appropriate behavioral health resources and care pathways, ensuring timely access to services
- Documented interactions accurately in internal systems to support continuity of care and quality standards
- Resolved customer inquiries efficiently, ensuring high satisfaction levels in service interactions.
- Collaborated with clinical staff to provide accurate information regarding behavioral health services.
Customer Service Representative
Elevance Health (Anthem NC)
Winston-Salem, NC
09.2022 - 12.2022
- Responded to internal and external inquiries via phone and written correspondence regarding medical insurance benefits and coverage.
- Investigated and routed medical claim denials and billing discrepancies to internal claims teams for timely resolution.
- Educated members on appropriate billing practices, preventing improper balance billing in accordance with Medicaid and payer policies.
- Analyzed member and provider issues to determine root cause and provide accurate information or solutions.
- Performed follow-up calls and emails to ensure inquiry resolution and member satisfaction.
- Documented all interactions thoroughly for accuracy, compliance, and tracking analysis.
- Resolved customer inquiries through multiple communication channels, ensuring timely and effective responses.
- Guided customers in navigating health insurance options, enhancing understanding of policy benefits and coverage.
- Collaborated with cross-functional teams to streamline processes, improving overall service efficiency and customer satisfaction.
Reimbursement Analyst
Blue Cross and Blue Shield of New Jersey
Newark, NJ
08.1999 - 07.2006
- Reviewed and analyzed insurance claims to identify processing errors, discrepancies, and payment variances.
- Resolved claim discrepancies through account research, corrections, and updates to ensure accurate reimbursement.
- Posted payments and adjustments to member and provider accounts in accordance with payer guidelines.
- Performed error revisions and information updates to maintain data accuracy and compliance.
- De-escalated member and provider inquiries related to claims and reimbursement issues through effective communication and problem resolution.
- Collaborated with internal teams to support timely claim resolution and customer satisfaction.
Education
GED -
Lincoln High School
Jersey City, NJ06-1980
Skills
Medicaid Member Services
Healthcare Customer Support
Behavioral Health Benefits
Insurance Claims Support
Billing & Balance Billing Resolution
HIPAA Compliance & Confidentiality
Identity Verification
First Call Resolution (FCR)
High-Volume Inbound Calls
Call Quality & CSAT
Empathy & De-escalation
Active Listening
Problem Solving
CRM Documentation
Multi-System Navigation
Data Entry & Accuracy
Microsoft Word
Microsoft Excel
Microsoft Outlook
Workday
Verint
Cisco Finesse
Citrix
Avaya
Finesse
Workday
Salesforce
CCS system
Timeline
Member Services Team Member
Intelogix LLC
04.2026 - Current
Medicaid Member Service Rep
Results Customer Solutions
10.2024 - 05.2025
Business-to-Business Customer Service Rep.
Wayfair LLC
08.2023 - 04.2024
Customer Service Representative – Mental Health
Carelon Behavioral Health
06.2023 - 08.2023
Customer Service Representative
Elevance Health (Anthem NC)
09.2022 - 12.2022
Reimbursement Analyst
Blue Cross and Blue Shield of New Jersey
08.1999 - 07.2006
GED -
Lincoln High School