Melissa Iwanski
Big Spring,TX
Summary
Quality-driven Member Service Specialist with impressive reputation and over 10 years of experience optimizing customer journey across diverse business environments. Effective in blending advanced communications and relationship building skills to optimize deliverables in call center environments.
Overview
23
23
years of professional experience
Work History
Member Service Specialist
Customer Contact Services
Minnetonka, MN
10.2023 - Current
- Provided exceptional customer service to members and guests by answering inquiries, resolving complaints, and providing information in a timely manner.
- Developed relationships with members to increase loyalty and satisfaction through personal contact, follow-up calls, and outreach activities.
- Researched discrepancies on member accounts and resolved issues promptly and accurately.
- Maintained accurate records of all transactions according to established procedures.
- Conducted periodic reviews of existing accounts for potential upgrades or changes.
Member Service Representative
Omnicare365
Durant, OK
11.2022 - 10.2023
- Answering and directing phone calls for Medicare Dual special needs plans
- Assisting with plan related issues
- Assisting members with submitting complaints and grievances
- Assisting members with coverage determinations and organizational determinations for their plan
- Updating members about prior authorizations and their OTC benefit card accounts
- Accurately records all calls as applicable
- Achieves individual performance goals as it relates to call center objectives
- Assists callers with Web Portal registration and utilization
- Engages and collaborates with other departments as applicable
- Verify eligibility for provider and members
- Reasonable for giving status of authorizations & Benefits to the providers
- Verified Registry provider through the NIP Registry for if we couldn’t find the provider company
- Worked with Medi-Cal member and Idaho member SIP-FIC for behavioral health & duals plans.
Quality Management Training Coordinator
West Texas Centers MHMR
Big Spring, TX
09.2019 - 06.2020
- Communicating with management to identify training needs
- Mapping out development plans for employees
- Manage, design, develop, and coordinate training programs.
Remote Receptionist
Full Creative Inc
Portland, OR
03.2017 - 04.2019
- First point of contact as a lead generator
- Deliver a superior experience to all clients
- Serve as point of contact for client inquiries
- Use multiple means of communication with clients - phone, chat, and email.
Provider Enrollment Specialist
Accenture
Austin, TX
01.2016 - 11.2016
- Responsible for the timely submission of provider enrollment applications
- Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and regulations
- Maintain documentation and reporting regarding provider enrollments in process.
Billing and Enrollment/Customer Service
Teleperformance Inc
Killeen, TX
08.2015 - 01.2016
- Responsible for the accurate enrollment and billing processes
- Taking payments for Humana Clients
- Assisting clients with account questions
- Helped with reinstatement of client accounts
- Educated clients on the Affordable Care Act
- Assist with claim inquiries
- Assist in enrollment question for United Healthcare Clients
- Knowledgeable with Affordable Care Act
- Familiar with coverage determinations and organizational determinations
- Assisted members with prior authorizations inquiries
- Familiar with Medicare part A, B, C, and D.
Student Services
Blackboard Inc
Killeen, TX
12.2014 - 02.2015
- Assist with students’ questions on financial aid
- Manage student's university accounts
- Assist with admissions and registration for major universities
- Provide customer service to advisors and students.
Customer Service Representative
Texas Medicaid & Healthcare Partnership
Austin, TX
03.2014 - 06.2014
- Answer healthcare providers on claim status
- Verified claim payment was paid to correct parties
- Verified Medicaid and Medicare eligibility for health providers
- Advised providers of payment adjustments and recoup amount.
Secretary
Merchants Metals
Pflugerville, TX
04.2013 - 10.2013
- Answer telephones and give information to callers, take messages, or transfer calls to appropriate individuals
- Complete forms in accordance with company procedures
- Compose, type, and distribute meeting notes, routine correspondence, and reports
- Greet visitors and callers, handle their inquiries, and direct them to the appropriate people according to their needs
- Locate and attach appropriate files to incoming correspondence requiring replies
- Mail newsletters, promotional material, and other information
- Open, read, route, and distribute incoming mail and other material, and prepare answers to routine letters
- Schedule and confirm appointments for clients, customers, or supervisors
- Set up and maintain paper and electronic filing systems for records, correspondence, and other material
- Collect and disburse funds from cash accounts and keep records of collections and disbursements
- Conduct searches to find needed information, using such sources as the Internet
- Coordinate conferences and meetings.
Eligibility Specialist
MAXIMUS INC
Austin, TX
12.2007 - 08.2010
- Actively provide case management services for the CHIP program, while also conducting eligibility screening for the Medicaid for Children and Pregnant Women's programs
- Facilitate productive working relationships with community agencies, ensuring the continual delivery of health and safety services
- Tasked with assessing individual and family eligibility for program admittance based on income and asset standards.
Medical Claims/Life Insurance Rep
GREAT AMERICAN FINANCIAL, INC
Austin, TX
01.2005 - 12.2005
- Sharp business acumen and experienced in managing broad scope of customer service operations, from preparing change-of-address records and issuing service discontinuance orders to handling billing complaints, exchanging merchandise and refunding money
- Successfully monitored client issue resolution and referred unresolved grievances for further investigation to maintain optimal client satisfaction levels
- Capably documented all customer interactions, including complaints, inquiries and actions taken to resolve client issues
- Assisted clients with their whole life insurance accounts and inquiries.
Help desk/Customer Service
AT&T Wireless
Austin, TX
01.2001 - 01.2002
- Utilized extensive knowledge of web-based tools in communicating with customers regarding account questions and billing inquiries
- Consistently ensured delivery of quality customer service vital to sustaining and growing a loyal clientele base
- Responsible for collecting account payments, activating new accounts and adjusting accounts based on client requests.
Education
Associate - communications
University of Phoenix
Phoenix, AZ05.2013
Bachelor’s Degree - business management
University of Phoenix-Online Campus
Phoenix, AZSkills
- Insurance verification
- Prior Authorization
- Credentialing
- Provider Enrollment
- Billing and Enrollment
- PBM Knowledge
- Claims processing
- ICD 9/10 coding
- Leadership
- Help Desk
- Technical Support
- Quality Assurance
- Operating systems
- Human Resources Management
- Customer Service
- Training & development
- Research
- Human Resources
- Quality Management
- Employee Orientation
- Recruiting
Download Speed
200Mbps
Upload Speed
20 Mbps
Typing Speed
35-40 Wpm
Availability
Available to interview ASAP
Timeline
Member Service Specialist
Customer Contact Services
10.2023 - Current
Member Service Representative
Omnicare365
11.2022 - 10.2023
Quality Management Training Coordinator
West Texas Centers MHMR
09.2019 - 06.2020
Remote Receptionist
Full Creative Inc
03.2017 - 04.2019
Provider Enrollment Specialist
Accenture
01.2016 - 11.2016
Billing and Enrollment/Customer Service
Teleperformance Inc
08.2015 - 01.2016
Student Services
Blackboard Inc
12.2014 - 02.2015
Customer Service Representative
Texas Medicaid & Healthcare Partnership
03.2014 - 06.2014
Secretary
Merchants Metals
04.2013 - 10.2013
Eligibility Specialist
MAXIMUS INC
12.2007 - 08.2010
Medical Claims/Life Insurance Rep
GREAT AMERICAN FINANCIAL, INC
01.2005 - 12.2005
Help desk/Customer Service
AT&T Wireless
01.2001 - 01.2002
Associate - communications
University of Phoenix
Bachelor’s Degree - business management
University of Phoenix-Online Campus
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