Mary Reeves
Spring,USA
Summary
Dynamic customer service professional with extensive experience at Centene, specializing in conflict resolution and claims processing. Seek to apply many years of professional experience and support customer needs in fast-pacsetting. Well-organized in handling simultaneous tasks, coordinating paperwork, and meeting quality objectives. Committed to maximizing customers satisfaction and loyalty. Dedicated customer service representative motivated to improve service satisfaction and contribute to overall company success. Well-developed communicator versed in corporate offerings and solutions.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Customer Service Advocate I
Centene
02.2024 - Current
- Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
- Mitigates and prevents complaints from being escalated to resolve in initial contact
- Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns
- Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if problems need to be routed to other departments for further resolution
- Maintains performance and quality standards based on established contact center metrics
- Provides customer service in a high pace contact center environment over the phone, via live chats and emails
- Documents all member or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications
- Remains up-to-date and adheres to quality standards, regulation, and all other policies to ensure quality, consistency, and compliance
- Performs other duties as assigned
- Complies with all policies and standards
- Handle member and provider calls regarding claims denial and billing information and CPT codes ICD 10
Team Member/Supervisor
Everise
Tampa, FL
08.2023 - 02.2024
- Company Overview: work from home
- Handle calls for 1.0 agents that was escalated
- Handle repeat callers On previous tickets
- Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if problems need to be routed to other departments for further resolution
- Use medical data for health care purposes and handling calls with Medicare and Medicaid for Wellcare
- Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
- Medical Terminology is use daily
- Work from home
Resolution Coordinator-seasonal
Walmart
05.2022 - 12.2022
- Company Overview: Remote.
- Assist customers with refund updates.
- I took past-due payments by phone.
- Provided help for customers to locate orders all over the U.S.
- Provide one-on-one training for new hires.
- Zoom training classes for new hires.
- Assist with IT technology issues for online orders.
- Remote
- Developed and implemented procedures for resolving complex customer disputes in accordance with company policies.
Trucking Dispatcher
TTN Fleet Solutions
11.2021 - 05.2022
- Company Overview: Remote
- As an Emergency Breakdown Services Dispatcher and Customer Service Advocate with TTN Fleet Solutions, i helping stranded truck drivers by dispatching roadside repair, tow service, accident management, and cargo recovery professionals. My training help me understand the needs of these drivers, dispatch the right solutions, and communicate with drivers and vendors for a successful outcome.
- Ability to evaluate a situation and determine the appropriate level of response
- Ability to remain calm, empathize and act with confidence during stressful situations
- Ability to establish and maintain effective working relationships
- Ability to multi-task in a dynamic fast-paced environment
- Ability to read maps and provide directions
- Remote
Patient Access Specialist III / medical courier
Hope and promise
Houston, TX
10.2011 - 09.2021
- Verifies insurance benefits for new patient
- Accurately evaluates charge prior to prepping billing to patient account
- Maintain patient information and insurance information via specified medial software
- Assist patient in finding referrals based off their insurance carrier
- Communicate daily with professional medical personnel (doctors, nurses, pharmacy staff, patient advocates) to carry out program operations
- Help Desk answering queries and addressing system
- Screen patients for eligibility and assists in applying for pharmaceutical or charitable drug assistance
- Perform blood draws and help collect Collect specimens
- Performs other job related duties as assigned.
- Negotiates payment plans on Patient Balance accounts utilizing established policies
- Maintain PHI and HIPAA compliance
- Delivery of the specimens and pharmaceuticals
Education
Certificate - Phlebotomist
Integrated Health Solutions
Houston, TX07-2023
High School Diploma -
Westfield High School
Houston, TX05-2003
Skills
- Customer service
- Conflict resolution
- Medical terminology
- Claims processing
- Quality assurance
- Contact center operations
Certification
- HIPPA and BBP certification
- Dispatching certified
- Notary certified for Texas
Languages
English
Professional
References
References available upon request.
Timeline
Customer Service Advocate I
Centene
02.2024 - Current
Team Member/Supervisor
Everise
08.2023 - 02.2024
Resolution Coordinator-seasonal
Walmart
05.2022 - 12.2022
Trucking Dispatcher
TTN Fleet Solutions
11.2021 - 05.2022
Patient Access Specialist III / medical courier
Hope and promise
10.2011 - 09.2021
Certificate - Phlebotomist
Integrated Health Solutions
High School Diploma -
Westfield High School