Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Languages
Timeline
Generic

Lydia Baggerman

client Intake/claims Rep
Lytle,TX

Summary

20 plus years of customer service experience that includes call center, medical customer service, Health Unit Coor., HR assistant. Prior Authorizations, Wound Care Rep, Fraud investigation, Fraud Claims Processing, Damage Claims Processing, Court Clerk and Remote Work. Authorized to work in the US for any employer

Client services professional with background in optimizing client onboarding and support strategies. Known for enhancing client satisfaction through effective communication and process improvements. Focused on team collaboration and adaptability, ensuring reliable performance in dynamic environment. Key skills include data management and client relations. 5 years Remote work Experience

Overview

27
27
years of professional experience
1
1
Certification

Work History

Client Intake Specialist

Phoenix Loss Control
05.2022 - Current
  • Receive calls from Internet and Cable Provider's regarding coax cable and fiber damage, intake all necessary information , create claim and dispatch claim to proper Investigation Rep or Investigation's Manager to assess and investigate damage. Contact Reps as needed for additional information needed for online claims submitted. Review claims for proper locate information and locate claim information. Input data as provided by the locate company to each claim as needed. Process all information within the claim..and review claims for errors and make corrections to claims as needed. Provide Copy of the claim to Technicians and Supervisors as needed.
  • Maintained strict confidentiality of sensitive client information, adhering to company policies and legal regulations.
  • Developed comprehensive client profiles through thorough data collection and analysis.
  • Optimized workflow processes, identifying areas for improvement and implementing necessary changes.
  • Promoted a client-centric approach within the team by consistently emphasizing the importance of understanding and addressing individual needs.

Fraud Specialist-Operations (Contract Temp)

Can-Am Consultants Keybank
04.2021 - 03.2022
  • Investigate Fraud Claims and Approve or Deny Claims based on findings. Review Bank Statements , Credit and Debit Funds as needed to accounts as needed per Bank Protocols. Refund fees per Bank Protocols. Close Claims per Bank Protocols, Process Charge Banks, send close Card Request. Other Duties as Assigned. Conducted Detailed investigations into Fraud claims to include Submitting Suspicious Activity Reports As Needed, Conducted Fraud Investigations and Processed Fraud Claims requiring Reg E Compliance. Experience working with Debit Card Fraud, Credit Card Fraud, Elder Fraud and Commercial Fraud Claims. Provided case management to each claim assigned to me keeping clients informed as to status and sending out letters etc as needed.
  • Conducted thorough investigations into suspected fraudulent activities, resulting in timely resolution of cases.
  • Improved customer trust by promptly addressing and resolving reported instances of fraud.
  • Identified trends in fraudulent activities through data analysis, which informed updates to anti-fraud strategies.
  • Reduced instances of fraud by implementing comprehensive detection and prevention strategies.

Fraud Operations Specialist 3

Citibank Customer Service
02.2019 - 11.2019
  • Answer Fraud Dept calls in a call center environment assisting customers nationwide who's Debit and Credit Card have been compromised or used in a fraudulent manner. Verify customer using a High Security Verification system, assist with shutting down customers Credit or Debit Card, verify charges with customers and dispute fraudulent purchases. Created and Submitted Claims involving Debit and Card Fraud for clients as needed.
  • Enhanced customer satisfaction with proactive communication and timely resolution of fraud cases.
  • Provided exceptional customer service during sensitive situations involving identity theft or account compromise while preserving customer trust in the company''s security measures.
  • Maintained accurate records of all investigated cases, ensuring proper documentation for audit purposes and regulatory compliance.

Customer Care Coordinator

101 Mobility
05.2018 - 11.2018
  • Handle all aspects of front office customer care. Answer phones and assist customers with Completion and Dispatch of Work orders for Repairs of DME equipment, Greet Customers and assist them on show room floor with Demonstrations of DME equipment. Create work orders and purchase orders . Assist with accounts receivable and payable invoice issues as needed. Organize and attend weekly office meetings with staff. Attend community events in the San Antonio area to demonstrate DME equipment available for purchase and rental. Collect payments for all DME EQ. Post refunds as needed. Make collection calls for overdue payments. Set repair appts for customers and dispatch technicians. Track company vehicles and Reconcile company credit cards and receipts. Assist with HR and Payroll for employees as needed. Other duties as assigned.
  • Took ownership of customers issues to follow problems through to resolution.
  • Assisted call-in customers with questions and orders.
  • Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
  • Trained new employees on best practices and customer care procedures to eliminate inefficiencies.
  • Created customer support strategies to increase customer retention.

CSR II

Centene Healthcare
07.2017 - 05.2018
  • Customer Service Rep Taking calls for Medicare Members in a call center environment, Managing Medicare Advantage Plans and assisting Members and Providers with all needs such as Benefits and Eligibility and Verification, Prior Auth, PCP changes, Transport Request and Scheduling appt's for members also handle all claims and grievances and appeals for members
  • Managed high call volumes, maintaining a professional demeanor during peak hours and effectively multitasking in a fast-paced environment.
  • Demonstrated empathy and active listening skills, resulting in a higher rate of customer satisfaction and repeat business.

Accounts Payable Clerk/Court Clerk

City of Wynnewood Oklahoma
11.2016 - 04.2017
  • Create/Submit/Print Purchase orders for payment. Issue| Mail checks to vendors each month following the approval of bills for payment by city council. Serve as Court Clerk for the City of Wynnewood, put Traffic tickets and other citations into system. Issuing warrants, attending to all matters of the court for City of Wynnewood. Operate cash Till and accept and post payments daily for Utility Bills and Court fines. Keep track of petty cash/ issues payments to vendors and employees. Assist HR w Payroll. Many other duties as assigned
  • Reviewed vendor invoices for appropriate documentation and validity prior to payment.
  • Prepared vendor invoices and processed incoming payments.
  • Assisted in month-end closing procedures, ensuring all invoices were processed on time to reflect accurate financial statements.
  • Maintained good working relationships with vendors and resolved disputes.
  • Reduced late payment penalties by closely monitoring due dates and managing timely payments.

HC & INSURANCE OPS SR ASSOCIATE

Synergy/Talent Wave @ Dell OKC Campus
05.2016 - 10.2016
  • Provide Provider Data Maintenance, performing the background work behind a claim. Includes Contract Loading, Fee Schedule loading, Tax ID Maintenance, Research and Terminating and Adding Providers to Contracts, as well as Credentialing Verification for Providers.
  • Streamlined operational efficiency by identifying areas for improvement and proposing actionable solutions.
  • Effectively managed multiple competing priorities while maintaining focus on delivering exceptional results for clients and the organization.

Staffing Coordinator/HR Assistant/Admin Assistant

Southpointe Rehabilitation & Skilled Care Center
10.2015 - 04.2016
  • Assist HR/Staffing Dept with Recruiting, Interviewing and Hiring, Conducting background checks, and drug screens for all new hires. Conduct employee training classes and New Employee orientation weekly. Ensure employee compliance for all employment related required testing such as TB test, hepatitis shots, and any required vaccinations assisting the director of nursing with required documentation . Maintain employee files and assist with finding staff when needed to work the floor. I worked in medical records as needed to help maintain compliance in accordance with HIPPA policy and procedures for release of medical records And correct medical record documentation for residents. Conduct regular audits of employee and resident files to ensure proper compliance with State Guidelines. Maintain the application system used by the company to ensure fair hiring practices for all applicants. Other duties as assigned by Administrator or HR Director.
  • Conducted interviews. Hired Applicants. Conducted State and National Background Checks on all applicants. Set up finger print appointments for all applicant's, conducted worker's comp checks. Provided training to all employees and applicants, facilitate new employee orientation. Conduct Pre employment and random drug screens for all employees.
  • Verified payroll, vacation and sick time hours to support accounting processes.
  • Assisted in onboarding new hires, facilitating a smooth transition into their roles and supporting employee retention efforts.
  • Increased client satisfaction by maintaining thorough knowledge of client needs and matching suitable candidates for open positions.

Prior Authorization Representative/Intake Rep/NPWT

St Francis Hospital and Medical Center/Asbury Medical Supply
05.2014 - 08.2015
  • May 2014/February 2014 Prior Auth Dept submitted and worked prior authorizations for various pieces of DME Equip/ Resp Equip and Supplies and Custom Power Equip submitting documentation to various insurance companies daily for approval or denial of payment . Made follow up status calls and spoke to insurance companies daily on a continuous basis about documentation provided. Continued to work each claim until an approval or denial was received. Created HCPC list and worked with various HCPC codes and ICD.9 medical codes to submit proper medical diagnosis and Equipment codes for review. Assisted billing dept with billing calls as needed. Entered authorizations in TIMS computer system for payment once approved or denied. Received calls daily from Various patients daily re DME general questions assisted customers and directed calls to correct dept for action. Submitted appeals claims for auth denials as needed for review to various insurance companies.
  • Scanned patient records as needed into EMR scanning system for paperless storage once a file is completed, recorded auth approval or denials. Worked with all insurances to ensure Medicare and Medicaid guidelines are followed for authorization as needed.
  • February 2014 promoted to Rehab Intake rep in the Rehab dept specializing in NPWT and assisting with Rehab paper work creation for billing purposes to insure proper insurance guidelines are followed for billing purposes for Rehab equip. Created paper daily using proper HCPC codes , Diagnosis Codes and Therapies as required by Medicare and Medicaid for payment under their guidelines. Researched proper HCPC codes and Current ICD codes for each item a patient was receiving on a daily basis. Checked Benefits and Eligibility and Verified proper Insurance on Each patient prior to creating paper work.
  • Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.

Health Unit Coordinator

Navarro Regional Medical Center
10.2012 - 02.2013
  • Answer pt's as they come to the floor, put together patient charts and put doctors' orders for the patients into the computer as needed, unit secretary for entire 2nd floor Med Sur. Answer patient call lights and dispatch appropriate nurse or Nurse Aide to assist patient as needed. Assist Doctors and nurses with all clerical duties related to patient care. Break down charts and discharge patients as they are discharged from the hospital. Contact Maintenance for repairs on the floor as needed. Other duties as assigned.
  • Supervisor: Tina Gafford
  • Shift: 10/2012 -02/2013 Hours per week: 40
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Enhanced communication between medical staff by promptly answering phone calls, relaying messages, and responding to inquiries.
  • Assisted nursing staff with daily tasks, contributing to a well-organized and efficient unit environment.

Customer Service Representative/HealthUnit Coordinator/Admin Assistant

Integris Health
02.1998 - 08.2012
  • Customer support-Integrated Services
  • Answer 300 plus calls per day in a call center environment.
  • Provide customer service assistance/Admin Assistance for internal and external customers for non emergency and emergency calls of various nature.
  • Provide customer service support for every department in the organization taking phone calls and assisting with clerical needs to include Human Resources, Payroll, Maintenance, Conference Center Education, Security and Patient Transport and Dispatch.
  • Dispatch and make work orders for Integris Health Maintenance Dept. all facilities.
  • Provide followup with customers and keep track of technicians time following completion of work.
  • Serve as One call Solution Center for every patient need that a patient may call down for and dispatch managers and staff as needed for resolution of patient care issues.
  • Order Supplies and Keep track of Departmental inventory and Machine Repair needs.
  • Order DME for patients while assisting as a back up unit clerk on the floors as needed.
  • Schedule Meeting Rooms and Catering for all Meetings in the Integris Health Conference Center Many other duties as needed and assigned.

Customer Service Representative

United Health Care
09.2010 - 04.2011
  • Take in coming calls in a call center environment answer questions related to medicare and medicaid and pharmacy billing. Assist with insurance verification for pharmacy medications for medicare and medicaid patients. Assist patients in ordering medications by phone and explaining coverage provided by their plan. Specifically helped explain coverage and limits regarding Medicare parts A and B.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.

Education

Business Administration -

Oklahoma City Community College
Oklahoma City, OK
01.2010

Business Management - undefined

OSU-OKC
Oklahoma City, OK
01.1995

Highschool Diploma - General Studies

Putnam City West
Oklahoma City, OK
01.1993

Skills

  • Human resources
  • Billing (10 years)
  • Medical scheduling (10 years)
  • Organizational skills
  • Dealership experience
  • Outlook (10 years)
  • Data management
  • Excel (10 years)
  • Communication skills
  • Workday
  • Meditech
  • Time management
  • Microsoft Outlook (10 years)
  • English
  • Customer Care (10 years)
  • Microsoft Powerpoint
  • Accounts payable
  • Microsoft Word
  • Customer service
  • Data collection
  • QuickBooks
  • Documentation review
  • Medicare
  • Word processing
  • Process improvement
  • Medical Billing (10 years)
  • Cash register
  • Clerical experience
  • Payroll
  • Epic (10 years)
  • Analysis skills
  • Receptionist
  • Patient service (10 years)
  • Sales
  • Typing
  • Autism experience
  • Conflict management
  • Windows (10 years)
  • EMR systems
  • Microsoft Word (10 years)
  • Interviewing
  • Customer Service (10 years)
  • Account management
  • Epic
  • Records management
  • Microsoft Outlook
  • Call Center (10 years)
  • IT
  • Insurance Verification (10 years)
  • Medical terminology
  • Behavioral health
  • Computer literacy
  • Negotiation
  • Recruiting
  • Investigator (5 years)
  • Customer Service, Dispatch, Prior Auth, Health Unit Coordinator, Healthcare Contract Building (10 years)
  • Crisis intervention
  • Data entry
  • Medical records
  • Contracts (10 years)
  • Fraud Prevention (5 years)
  • Computer skills
  • Cash handling
  • Data Entry (10 years)
  • Front desk
  • Credit analysis
  • Microsoft Excel (10 years)
  • Windows
  • Oracle
  • CSR (10 years)
  • Organizational Skills (10 years)
  • Filing (10 years)
  • Scheduling
  • Microsoft Excel
  • Investigation (5 years)
  • Microsoft Office (10 years)
  • Microsoft Office
  • DME (10 years)
  • Medical billing
  • Customer Support
  • HCPCS (10 years)
  • Follow-up skills
  • Client education
  • Client assessment
  • Patient scheduling
  • Multi-line phone systems
  • Charting and clinical documentation
  • Confidentiality
  • Multi-line phone operations
  • Teamwork
  • Teamwork and collaboration
  • Scheduling appointments
  • Insurance verification
  • Inventory management
  • Problem-solving
  • Efficient multi-tasker
  • Attention to detail
  • Writing skills
  • Problem-solving abilities
  • Multitasking
  • Note-taking
  • Excellent communication
  • Critical thinking
  • Reliability
  • Multitasking Abilities
  • Team collaboration
  • Active listening
  • Effective communication
  • Professional communication
  • Court filings
  • Decision-making
  • Verbal and written communication
  • Adaptability and flexibility
  • Office administration
  • Relationship building
  • File organization
  • Legal procedures
  • Clerical assistance
  • Team coordination
  • Research and data collection
  • Legal document preparation
  • Documentation and recordkeeping
  • Legal research
  • Drafting legal documents
  • Microsoft office
  • Office equipment use
  • Memo drafting and typing
  • Team building
  • Document scanners
  • Public relations
  • Document filing
  • Self motivation
  • Work Planning and Prioritization
  • Task prioritization
  • Interpersonal skills
  • Client relations
  • Typing speed 35 WPM

Accomplishments

  • Collaborated with team of 25 in the development of New Software.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.

Certification

Driver's License

Languages

English
Native or Bilingual

Timeline

Client Intake Specialist

Phoenix Loss Control
05.2022 - Current

Fraud Specialist-Operations (Contract Temp)

Can-Am Consultants Keybank
04.2021 - 03.2022

Fraud Operations Specialist 3

Citibank Customer Service
02.2019 - 11.2019

Customer Care Coordinator

101 Mobility
05.2018 - 11.2018

CSR II

Centene Healthcare
07.2017 - 05.2018

Accounts Payable Clerk/Court Clerk

City of Wynnewood Oklahoma
11.2016 - 04.2017

HC & INSURANCE OPS SR ASSOCIATE

Synergy/Talent Wave @ Dell OKC Campus
05.2016 - 10.2016

Staffing Coordinator/HR Assistant/Admin Assistant

Southpointe Rehabilitation & Skilled Care Center
10.2015 - 04.2016

Prior Authorization Representative/Intake Rep/NPWT

St Francis Hospital and Medical Center/Asbury Medical Supply
05.2014 - 08.2015

Health Unit Coordinator

Navarro Regional Medical Center
10.2012 - 02.2013

Customer Service Representative

United Health Care
09.2010 - 04.2011

Customer Service Representative/HealthUnit Coordinator/Admin Assistant

Integris Health
02.1998 - 08.2012

Business Management - undefined

OSU-OKC

Highschool Diploma - General Studies

Putnam City West

Business Administration -

Oklahoma City Community College

Similar Profiles

CREATE PROFILE
Lydia Baggermanclient Intake/claims Rep