Malaysia White
Kingwood
Summary
Experienced and detail-oriented customer service and healthcare support professional with 3+ years of experience working remotely. Strong background in provider and patient communication, claims processing, account management, and technical troubleshooting. Proven ability to handle sensitive data with care, manage multiple systems, and resolve issues efficiently in high-pressure environments.
Overview
4
4
years of professional experience
Work History
Member Service Specialist
Highmark Blue Cross Blue Shield
Remote
01.2024 - Current
- Manage a high volume of client calls and chats to assist with claims and policy inquiries.
- Accurately enter and update client information in CRM systems.
- Demonstrated commitment to patient privacy by maintaining strict confidentiality in accordance with HIPAA regulations.
- Process and verify insurance details for benefit quotes.
- Analyzed trends in claim submissions to identify areas for process improvement and cost reduction.
- Followed up with customers on unresolved issues.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
- Resolved customer inquiries efficiently, ensuring high satisfaction levels and timely follow-ups.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Assisted customers in understanding policy details and coverage options.
- Processed policy updates and changes accurately, ensuring client needs were met in a timely manner.
- Responded to customer requests for products, services, and company information.
- Facilitated communication between patients and healthcare providers to enhance care coordination.
- Demonstrated empathy toward diverse patient populations, building trust through compassionate interactions.
Medical Billing Representative (Temp)
PFS Group
Remote
06.2023 - 01.2024
- Delivered support via phone, chat, and email.
- Resolved billing discrepancies and clarified service charges for customers.
- Oversaw daily billing operations, ensuring compliance with regulations and accuracy in claims submission.
- Collaborated with healthcare providers to resolve discrepancies and optimize reimbursement cycles.
- Evaluated claim documentation for accuracy, completeness, and adherence to regulations.
- Entered detailed notes into client accounts to ensure accurate service continuity.
- Provided exceptional customer service by addressing inquiries and guiding clients through the claims process.
- Managed multiple web-based systems and browser tabs simultaneously.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Assisted with troubleshooting client logins and technical access issues.
- Built strong rapport with repeat customers to improve service retention.
- Ensured high-quality service despite high call/chat volumes.
- Prioritized patient confidentiality, adhering to HIPAA guidelines and safeguarding sensitive information at all times.
Patient Care Advocate
Accredo (Express Scripts/Cigna)
Remote
02.2022 - 05.2023
- Served as a key contact between patients, providers, and insurance representatives.
- Scheduled specialty medication deliveries and ensured refill compliance.
- Verified insurance coverage and obtained prior authorizations as needed.
- Documented detailed case notes in multiple secure systems.
- Assisted in resolving claims denials or coverage changes with empathy and accuracy.
- Maintained compliance with HIPAA regulations and privacy standards.
- Handled sensitive conversations regarding chronic illness and treatment logistics.
- Followed up with providers to confirm prescriptions, renewals, or modifications.
- Built lasting relationships with patients and ensured continuity of care.
Education
Associate of Arts - Communications
Southern University
Baton Rouge08-2019
Skills
- Patient & Provider Support
- Insurance & Billing Coordination
- CRM & Documentation Tools
- Insurance claims review
- Time management
- Coverage determination
- Settlement negotiation
- Documentation review
- Workers compensation
- Conflict resolution
- Customer service
- Attention to detail
- Active listening
- Critical thinking
- Teamwork and collaboration
- Eligibility determination
Timeline
Member Service Specialist
Highmark Blue Cross Blue Shield
01.2024 - Current
Medical Billing Representative (Temp)
PFS Group
06.2023 - 01.2024
Patient Care Advocate
Accredo (Express Scripts/Cigna)
02.2022 - 05.2023
Associate of Arts - Communications
Southern University