Melonie Bolton

Essential Functions

• Ensure accurate and timely processing of all requests by taking appropriate action, such as scheduling appointments, taking messages, transferring calls to appropriate staff.
• Resolve patient issues through independent problem solving and with a goal of first call.

Required Qualifications

• Strong customer service skills with an emphasis on written and oral communication to respond to inquiries and service requests professionally.
• Active listening, with a high degree of empathy
• Ability to remain calm and helpful even when dealing with upset patients.
• Demonstrate a patient centric mindset and a high sense of urgency to solve patient requests.
• Knowledge of basic help desk software, computer software and Microsoft Office applications including Microsoft Word, Excel, and Outlook

• Answered member questions about products and services
• Managed customer conflicts and challenging situations by staying calm and accessing internal knowledge bases to develop strategic solutions
• Helped members resolve account problems and navigate internal systems to handle routine needs
• Consulted with customers regarding needs and addressed concerns
• Enhanced member relationships by providing excellent service during each interaction
• Reviewed claims for accuracy before submitting them for billing
• Stayed current on HIPAA regulations, benefits claim processing, medical terminology, and other procedures
• Coordinated benefits processing, including enrollments, terminations, and claims.

• Escalated issues to correct individuals when typical procedures did not achieve resolution
• Attended training sessions to grow knowledge of company products and services
• Assisted customers with billing, troubleshooting, and account issues
• Updated customer information into account databases for future use
• Examined claims, records, and procedures to approve coverage
• Modified and updated existing policies and claims to reflect changes in beneficiary, amount of coverage, or type of insurance
• Checked documentation for appropriate coding, catching errors and making revisions.