Malaysia White
Kingwood
Summary
Experienced and detail-oriented customer service and healthcare support professional with 3+ years of experience working remotely. Strong background in communication, account management, billing and technical troubleshooting. Proven ability to handle sensitive data with care, manage multiple systems, and resolve issues efficiently in high-pressure environments.
Overview
6
6
years of professional experience
Work History
Member Service Specialist
Blue Cross Blue Shield
Remote
09.2024 - 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.
- Analyzed appeals documentation for compliance with regulatory standards and internal policies.
- Facilitated benefits verification processes to ensure accuracy and compliance with policy guidelines.
- Reviewed medical documentation to determine eligibility for various benefit programs.
- Analyzed authorization requests for compliance with policy guidelines and protocols.
- Managed complex cases requiring detailed review and coordination across departments.
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Provided excellent customer service by actively listening to customer concerns and empathetically addressing their needs throughout the appeals process.
- Completed documentation of final appeals or grievance determination using appropriate templates.
- Educated clients on policy options, benefits, and enrollment processes to facilitate informed decisions.
- Assisted older adults in navigating Medicare benefits by offering one-on-one consultations explaining coverage options and enrollment procedures.
- Assisted clients in understanding Medicaid benefits and eligibility requirements through clear communication.
- Collaborated with healthcare providers to resolve billing issues, facilitating prompt payment of claims.
Customer Service Representative
Safelite
Remote
06.2023 - 08.2024
- Delivered support via phone, chat, and email.
- Resolved billing discrepancies and clarified service charges for customers.
- 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.
- Managed multiple web-based systems and browser tabs simultaneously.
- Improved customer satisfaction by providing timely and accurate information.
- 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.
- Utilized electronic health record (EHR) systems to streamline documentation and improve billing accuracy.
Patient Care Advocate
Express Scripts- Cigna
Remote
02.2020 - 05.2023
- Served as a key contact between customers, 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
- Customer Service
- Exceptional communication
- Strong empathy
- Data entry proficiency
- Workflow management
- Call center operations
- CRM
- Teamwork and collaboration
- Payment processing
- Product knowledge
- Appointment scheduling
- Documentation
- Administrative support
- Building rapport
- Live chat support
- Dispute resolution
- Account management
- Claims processing
- EHR management
- Multitasking and organization
- Quality assurance
Timeline
Member Service Specialist
Blue Cross Blue Shield
09.2024 - Current
Customer Service Representative
Safelite
06.2023 - 08.2024
Patient Care Advocate
Express Scripts- Cigna
02.2020 - 05.2023
Associate of Arts - Communications
Southern University